Eye-related intrabody pressure identification and modification

ABSTRACT

An apparatus for at least one of diagnosing or treating an eye condition can include a goggle enclosure, sized and shaped to be seated on an eye socket of an eye to provide one or more cavities within the enclosure that extend about an entire exposed anterior portion of the eye, a pump, in fluidic communication with the one or more cavities to apply a fluid pressure to the one or more cavities, the pump configured to adjust a fluid pressure within the one or more cavities of the goggle enclosure, and a control circuit, including a data interface to receive data directly or indirectly indicating at least one of an intraorbital pressure, ICP, IOP, or a relationship between ICP and IOP, and based on processing the received data as a feedback control variable, controlling the pump to adjust the fluid pressure within the one or more cavities, the controlling including using further monitoring of the received data to control the pump.

CLAIM OF PRIORITY

This patent application is a continuation of U.S. patent applicationSer. No. 15/754,723, entitled “Eye-Related Intrabody PressureIdentification and Modification”, filed Feb. 23, 2018, which is acontinuation of U.S. National Stage Application Under 35 U.S.C. 371 fromInternational Application Number PCT/US2016/048784, filed Aug. 25, 2016,which claims the benefit of priority of U.S. Provisional PatentApplication Ser. No. 62/210,751, entitled “Detecting Intrabody PressureUsing Eye Blood Vessel Characteristic,” filed on Aug. 27, 2015 and ofU.S. Provisional Patent Application Ser. No. 62/311,052, entitled“Apparatus and Methods for Ocular Pressure Modification,” filed on Mar.21, 2016, all of which are hereby incorporated by reference in theirentirety.

BACKGROUND

Measuring eye pressure is important in diagnosing and treating diseasesof the eye, such as glaucoma. Early diagnosis and treatment of glaucomais a key to inhibiting or preventing loss of vision. Non-contactingtonometers are useful instruments for measuring eye pressure, but cancause patient discomfort in use.

U.S. Pat. No. 4,724,843 mentions a tonometer that fires a controlledpuff of air onto the cornea.

U.S. Pat. No. 5,523,808 mentions a composite ophthalmic apparatus withan intraocular pressure measuring system for spraying a fluid from anozzle against an eye.

U.S. Pat. No. 6,673,014 mentions noninvasive methods and apparatuses formeasuring the intraocular pressure of the eye using vibratoryexcitation.

US Patent Application 2013/0211285 mentions systems and methods fornoninvasively assessing intracranial pressure by controllably osculatingat least a portion of a subject's ocular globe while applying a forcesufficient to collapse an intraocular blood vessel and correlating thecollapse pressure to intracranial pressure.

U.S. Pat. No. 9,125,724 mentions assemblies and methods that can be usedto treat, inhibit, or prevent ocular conditions.

US Patent Application 2015/0313761 mentions assemblies and methods thatcan be used to treat, inhibit, or prevent ocular conditions.

OVERVIEW

An apparatus for at least one of diagnosing or treating an eye conditioncan include a goggle enclosure, sized and shaped to be seated on an eyesocket of an eye to provide one or more cavities within the enclosurethat extend about an entire exposed anterior portion of the eye, a pump,in fluidic communication with the one or more cavities to apply a fluidpressure to the one or more cavities, the pump configured to adjust afluid pressure within the one or more cavities of the goggle enclosure,and a control circuit, including a data interface to receive datadirectly or indirectly indicating at least one of an intraorbitalpressure, ICP, TOP, or a relationship between ICP and TOP, and based onprocessing the received data as a feedback control variable, controllingthe pump to adjust the fluid pressure within the one or more cavities,the controlling including using further monitoring of the received datato control the pump.

This overview is intended to provide an overview of subject matter ofthe present patent application. It is not intended to provide anexclusive or exhaustive explanation of the invention. The detaileddescription is included to provide further information about the presentpatent application.

BRIEF DESCRIPTION OF THE DRAWINGS

In the drawings, which are not necessarily drawn to scale, like numeralsmay describe similar components in different views. Like numerals havingdifferent letter suffixes may represent different instances of similarcomponents. The drawings illustrate generally, by way of example, butnot by way of limitation, various embodiments discussed in the presentdocument.

FIG. 1A shows a lateral cross section of an example of a human eye.

FIG. 1B shows an example of pressures associated with a physiologicallynormal eye.

FIG. 2 shows an example of an assembly, such as for applying fluidpressure to an external surface of the eye, such for at least one ofdiagnosing or treating an eye condition, such as can include an abnormaleye condition.

FIG. 3 shows an example of a goggle enclosure including a port.

FIG. 4 shows an example of a multi-part goggle enclosure.

FIG. 5 shows an example of a feedback control system.

FIG. 6 shows examples of detector devices that can be used in or incombination with the apparatus.

FIG. 7 shows an example of a tonometer included in or used incombination with an example of an apparatus.

FIG. 8 shows examples of a visualization assistance device (or VAD) thatcan be included in or used in combination with the apparatus.

FIG. 9 shows an example of a method for using the apparatus.

FIG. 10 shows an example of a method for using the apparatus to apply apressure to an eye to monitor ICP.

FIG. 11 shows an example of a method for using the apparatus to apply apressure to an eye, such as for determining ICP or monitoring ICP.

FIG. 12 shows an example of a method for using the apparatus, such asfor determining an indication of ICP.

FIG. 13 shows an example of a method for using the apparatus forsynchronizing pressure applied to the goggle enclosure with the patientcardiac cycle.

FIG. 14 shows an example of a method for using the apparatus fordetermining ICP based upon an indication of the patient cardiac cycle.

FIG. 15 shows an example of a method, such as for conducting adiagnostic examination of the eye after concluding a therapeutic sessionusing the apparatus.

FIG. 16 shows an example of a method for determining at least one of ICPor IOP using the apparatus, such as for diagnostic purposes.

FIG. 17 shows an example of a method for using the apparatus, such asfor therapeutic purposes including treating at least one of an acute ora chronic abnormal eye condition.

FIG. 18 illustrates an example method of setting and adjusting atherapeutic pressure using IOP for application to an eye, such as fortreatment of an abnormal eye condition.

DETAILED DESCRIPTION

FIG. 1A shows a lateral cross section of an example of a human eye 100.The eye 100 includes two chambers within the sclera 122; an anteriorchamber 104 and a posterior chamber 116. The anterior chamber 104 isdefined generally as the space between the cornea 102 and the iris 106and is filled with aqueous humor. The pupil 107 is a hole defined by theiris 106 that allows light to enter the eye 100. The lens 110 is locatedbehind the iris 106 and is supported by ligaments 112. The ciliaryprocesses 114, which include the ciliary body and ciliary muscle,surround the lens 110 and are located behind the iris 106.

The posterior chamber 116, located between the anterior chamber 104 andthe retina 120, is filled with vitreous humor. The retina 120 issupported structurally and physiologically by the choroid 123 locatedbetween the retina 120 and the sclera 122.

Collectively, the anterior and posterior chambers 104, 116 are referredto as the intraocular space of the eye 100. The anterior chamber 104 isdistinct from the posterior chamber 116, however, the separation betweenthe two chambers is elastic so that fluid pressures due to the aqueoushumor and viscous humor are equal or approximately equal at any giventime. The pressure of the fluids in the intraocular space can bereferred to as the intraocular pressure, or TOP.

The optic nerve 118 connects the retina 120 to the brain to delivervisual stimuli from the retina 120 to the brain for processing. Theoptic nerve 118 is surrounded by the dural sheath 119 and bathed incerebrospinal fluid (CSF). As the dural sheath 119 is in fluidcommunication with the intracranial space, CSF pressure is equal to orapproximately equal to the intracranial pressure (ICP).

The optic disc 150 (or optic nerve head) connects the optic nerve 118 tothe retina 120. The optic disc 150 is visible on the surface of theretina 120 and can assume a generally circular shape, such as an oval,with an orange-pink coloration indicating the presence of well-perfusednerve tissue. The optic disc 150 can include a centrally-located,cup-like depression referred to as the optic cup 154 that can appearpale in contrast to the orange-pink color of the optic disc 150.

The ratio of the diameter of the optic cup 154 to the diameter of theoptic disc 150 can be referred to as the cup-to-disc ratio. In an eye100 that is generally healthy, such as a non-glaucomatous eye, acup-to-disc ratio of approximately 0.3 is generally considered normal.Cup-to-disc ratios greater than or less than approximately 0.3 canindicate damage to the optic nerve 118, such as with the progression ofan eye disease including glaucoma and optic disc edema.

The intraocular space is separated from the intracranial space by thelamina cribrosa 124, a mesh-like, collagenous membrane structure locatedin the posterior portion of the sclera 122. Fibers of the optic nerve118 can weave through the lamina cribrosa 124 to connect the retina 120to the brain while the lamina cribrosa 124 can maintain a pressuredifferential between the intraocular and intracranial spaces. Theintraocular surface of the lamina cribrosa 124 a is exposed to IOPwhereas the intracranial surface of the lamina cribrosa 124 b is exposedto ICP. The lamina cribosa 124 is more flexible than the adjacent sclera122 and can deform under the influence of a translaminar pressuredifference (TPD), which is the difference between the IOP and the ICP(e.g., TPD=IOP−ICP) at any given time. The translaminar pressuregradient (TPG) can be represented by the difference between the IOP andthe ICP divided by the thickness of the lamina cribrosa 124. In a normaleye 100, IOP is generally greater than ICP and thus, the lamina cribrosais ordinarily subjected to a posteriorly directed pressure difference,such as to cause the laminar cribrosa 124 to bow outwardly from theintraocular space to form the optic cup 154 in the optic disc 150. In aneye 100 that is generally healthy, a physiologically normal TPD isapproximately 4 mmHg. Under the influence of the physiologically normalTPD, the lamina cribrosa 124 can support the optic disc 150 in a nominalposition, such as to form a cup-to-disc ratio of about 0.3.

Changes in TPD can indicate the presence of an eye condition, such as anabnormal eye condition, in the eye 100. As TPD increases from thephysiologically normal TPD, such as due to the effects of increasingIOP, decreasing ICP, or both, the lamina cribosa 124 can deflectposteriorly from the nominal position causing the optic cup 154 toincrease in diameter, such as to increase the cup-to-disc ratio to avalue greater than about 0.3. As TPD decreases from the physiologicallynormal TPD, such as due to the effects of increasing ICP, decreasingIOP, or both, the lamina cribrosa 124 can deflect anteriorly from thenominal position causing the optic cup 154 to decrease in diameter, suchas to decrease the cup-to-disc ratio to a value less than about 0.3.

Changes TPD can be positively correlated with diseases of the eye 100.For example, glaucoma can arise from an imbalance between IOP and ICP.An increase in IOP or a decrease in ICP can create a pressuredifferential across the optic nerve 118. ICP can affect the optic nerve118, such as in pseudotumor cerebri (idiopathic intracranialhypertension) in which elevated ICP can force the optic nerve to bowforward, such as from a physiologically normal position, and inglaucoma, where reduced ICP can force the optic nerve 118 to cup, suchas in cupping of the optic nerve 118, such as because a high IOP and alow ICP can force the optic nerve backwards, such as from aphysiologically normal position.

Eye diseases, such as glaucoma, can also result from other disorders,such as a metabolic disease or disorder. In a normal eye 100, such as aneye 100 with physiologically normal function, axonal transport throughthe optic nerve can service the metabolic needs of ganglion cells acrossthe lamina cribrosa. In an abnormal eye 100, such as an eye withoutphysiologically normal function, such as an eye 100 experiencing anelevated IOP, a reduced ICP, or both, axonal transport can be impeded,or potentially stopped, from passing through the lamina cribrosa, suchas may cause ganglion cell death and the occurrence of glaucoma.

Changes in TPD can be positively correlated with visual field loss, suchas loss associated with damage to the optic nerve 118 due to a reductionin axonal transport. Axonal transport can describe the collection ofcellular processes required to maintain the viability of nerve cells inthe eye 100, such as metabolic processes. A decrease in axonal transportcan occur when cellular processes supporting the optic nerve 118 andretina 120 are impeded, such as when a patient experiences a TPD in oneor both eyes 100 that is elevated or reduced from the physiologicallynormal TPD.

The duration of time that axonal transport is impeded in the eye 100 canaffect the extent of damage suffered by the optic nerve 118. While thedeleterious effects on the optic nerve 118 of acute decreases in axonaltransport, such as due to short-term increases or decreases of TPD froma physiologically normal TPD, can be reversible, chronic changes inaxonal transport, such as due to long-term increases or decreases of TPDfrom a physiologically normal TPD, can be related to permanent damage ofthe optic nerve 118.

The eye 100 is supplied with oxygenated blood from the circulatorysystem by several branches of the ophthalmic artery, including thecentral retinal artery 130, the anterior ciliary artery, and theposterior ciliary artery. The central retinal artery 130 perfuses theoptic nerve 118 and the retina 120. The anterior and posterior ciliaryarteries together perfuse the ciliary processes 114, the iris 116, thesclera 122, and the choroid 132. Deoxygenated blood is returned to thecirculatory system via the central retinal vein 133 and the vortex veinswhich drain into the superior and inferior ophthalmic veins. The centralretinal vein 133 passes through the subarachnoid space of the opticnerve 118 and is bathed in CSF at the ICP of the patient before draininginto the cavernous sinus. As a result, the pressure in the centralretinal vein 133 is equal to or higher than the ICP. A linearcorrelation exists between the pressure in the central retinal vein 133and ICP.

The eye 100 can be subjected to at least three different pressures atany given time, such as an atmospheric pressure on the exposed anteriorportion of the eye 100, an IOP in the intraocular space of the eye 100,and an ICP on the posterior portion of the eye 100 surface. Bloodvessels in the eye 100, such as venous blood vessels including thecentral retinal vein 133, can pass through the subarachnoid space of theoptic nerve 118 and can be bathed in cerebrospinal fluid at theintracranial pressure of the patient, such as before draining into thecavernous sinus. As a result, the pressure in a venous blood vessel,such as the intraluminal pressure in the central retinal vein 133, canbe equal to or greater than ICP.

The ocular pulse cycle can be characterized by the ocular pulseamplitude, such as the difference between systolic and diastolicintraocular pressure. The ocular pulse cycle, such as the systolic anddiastolic intraocular pressure of the eye 100, can be related to thecardiac cycle of the patient. The intracranial pulse cycle can becharacterized by the intracranial pulse amplitude, such as thedifference between systolic and diastolic intracranial pressure. Theintracranial pulse cycle, such as the systolic and diastolicintracranial pressures, can be related to the cardiac cycle of thepatient.

FIG. 1B shows an example of pressures associated with a physiologicallynormal eye 100. IOP can be greater than ICP, such as about 4 mmHggreater than ICP. IOP can include a quasi-static IOP component, such asan average IOP, such as can slowly vary over time due to physiologicalconditions of the eye 100, and a dynamic IOP component, such as avarying component of IOP, such as can vary with at least one indicationof the cardiac cycle of the patient. At 162, the dynamic IOP componentcan be in-phase, such as with an indication of the cardiac cycle of thepatient. At 164, the dynamic IOP component can be out-of-phase with anindication of the cardiac cycle of the patient. ICP can include aquasi-static ICP component, such as an average ICP, such as can slowlyvary over time due physiological conditions of the patient, and adynamic IOP component, such as a varying component of ICP, such as canvary with at least one indication of the cardiac cycle of the patient.At 163, the dynamic ICP component can be in-phase, such as with anindication of the cardiac cycle of the patient. At 165, the dynamic ICPcomponent can be out-of-phase with an indication of the cardiac cycle ofthe patient.

Transmural pressure (TMP) can be defined as the difference between theintraluminal pressure of a vessel of the patient eye 100, such as thepressure in the central retinal vein 133 including ICP, and a chamberpressure of the patient eye 100, such as IOP. The TMP can be related toan eye characteristic, such as an SVP including an indication of SVP,such as a change in caliber of a blood vessel in the eye 100. At 166,the in-phase dynamic IOP component and the in-phase dynamic ICPcomponent can combine, such as destructively interfere, such as tominimize the dynamic component of TMP. At 167, the in-phase dynamic IOPcomponent and the in-phase dynamic ICP component can combine, such asconstructively interfere, such as to maximize the dynamic component ofTMP.

Spontaneous venous pulsations (SVP) occur in venous vessels of the eye100, such as the central retinal vein. SVP occur near the site of largevenous pressure changes, such as the pressure gradient between IOP andICP experienced at the retrobulbar optic nerve, within highly compliantvessels, such as veins of the eye 100. The pulsation characteristics ofSVP can depend upon several variables, such as IOP and ICP.

ICP can be non-invasively estimated by temporarily increasing IOP in aneye 100 of a patient. In an example, an instrument can be placed incontact with the eye 100, such as an anterior portion of the eye 100,and the instrument pressed against the eye 100, such as to increase theIOP of the eye 100. One or more blood vessels, such as venous bloodvessels, in the eye 100 can be observed by a person other than thepatient, such as a medical professional, while the IOP of the eye 100 isincreased until at least one criterion, such as an eye characteristicchange criterion, is achieved. In an example, an eye characteristicchange criterion can include the collapse of the central retinal vein133, such as due to increased IOP in the eye 100.

Removal of the instrument pressed against the eye 100 can decrease theIOP of the eye 100, such as to allow a collapsed vessel to regain agenerally circular cross-sectional shape. One or more blood vessels,such as venous blood vessels, in the eye 100 can be observed by a personother than the patient, such as a medical professional, while the IOP ofthe eye 100 is decreased until a criterion, such as an eyecharacteristic rebound criterion, is achieved. Detection of an eyecharacteristic rebound criterion can indicate that the affected bodytissue has recovered to an ambient state, such as a normal physiologicalstate as existed before applying the instrument pressed against the eye100. In an example, an eye characteristic rebound criterion can includethe recovery of the central retinal vein 133 to an ambientcross-sectional shape, such as a generally circular shape.

An eye characteristic can describe a physical feature of the body of apatient, such as at least one of a physical feature of a patient eye 100or a physical feature of the patient body related to the patient eye100. An indication of an eye characteristic can include a numericalvalue associated with a particular level or quantity of an eyecharacteristic. A numerical value can represent a single indication ofan eye characteristic, such as a first value or a second value, or achange in an indication of an eye characteristic, such as the differencebetween the first value and the second value.

Indications of eye characteristics associated with the eye 100 canchange under the influence of forces applied to the body of a patient,such as when the body of a patient is subjected to inertial forces.Inertial forces can be generated within the eye 100, such as by suddenacceleration or deceleration of the eye 100.

Indications of eye characteristic associated with the eye 100 can changeunder the influence of changes in hydrostatic pressures, such asdifferential hydrostatic pressures, in the body of the patient. Eyecharacteristic associated with the eye 100 can change due to changes inhydrostatic IOP and ICP, such as a patient transitioning from a firstbody position, such as a standing position, to a second body position,such as a sitting or prone position. Changes in indications of eyecharacteristics subjected to differential hydrostatic pressures caninclude a change in the caliber or diameter of blood vessels, such as atleast one of a retinal vein or a retinal artery. A change in the caliberor diameter of a blood vessel can include a pulsation, such as apulsation detected by an imaging device due to changes in systemic bloodpressure, such as during systole and diastole, can be indicative of thecardiac cycle.

Indications of eye characteristics associated with the eye 100 canchange under the influence of forces applied to the eye 100, such aswhen the eye 100 is subjected to gauge pressures applied to the cavity212 of the goggle enclosure 210 by the apparatus 200. Forces can begenerated on the anterior surface of the eye 100 by applying fluidpressures, such as positive or negative gauge pressures, to the cavity212 with the pump 220.

Indications of eye characteristics associated with the eye 100 can becalculated, or otherwise estimated, as a function of one or moreparameters including one or more indications of eye characteristics andone or more indications of body parameters, such as at least one of bodymass index (BMI) of a patient or chronological age of a patient. Anindication of ICP can include an estimate of CSF pressure, such as anestimate of CSF pressure calculated based upon knowledge of bloodpressure, BMI, and chronological age of the patient.

An eye characteristic can include an intrabody pressure of the eye 100.An intrabody pressure can include a pressure associated with the eye100, such as at least one of an IOP, an ICP, an episcleral venouspressure (EVP), or a pressure between the eye 100 and the body of thepatient, such as a translaminar pressure difference (TPD), translaminarpressure gradient (TPG), or an orbital pressure. Intracranial pressure(ICP) can sometimes be referred to as cerebrospinal fluid pressure(CSFP).

An eye characteristic can include a physical characteristic of the eye100, such as a physical characteristic that describes or can beassociated with the structure of the eye 100. A structure of the eye 100can include components of the eye, such as the lamina cribrosa 124, theretina 120 including the retinal nerve fiber layer (BNFL), and thechoroid 123. A physical characteristic of a structure of the eye 100 caninclude at least one of the thickness of the structure, the color of thestructure, the reflectance of the structure, such as can be related tothe color and reflectivity of the structure, or motion of the structurein the eye 100, such as relative to at least one of a structure outsidethe eye 100, such as at least one of a visualization assistance deviceor a goggle enclosure 210, or with respect to a structure of the eye100. In an example, an eye characteristic can include the motion of thelamina cribrosa, such as at least one of motion with respect to astructure outside the eye 100, or motion with respect to a structure ofthe eye, such as motion of the lamina cribrosa with respect to theanterior surface of the eye 100. A structure of the eye 100 can includea blood vessel of the eye 100, such as an arterial vessel or a venousvessel such as can include the central retinal vein 133. A physicalcharacteristic of the blood vessel of the eye 100 can include across-sectional caliber (or diameter) of the blood vessel, such as thecaliber of the central retinal vein 133 or the shape of the bloodvessel, such as the cross-sectional shape of the central retinal vein133. In an example, pressure in the central retinal vein 133 canapproximate ICP. A physical characteristic of a blood vessel of the eye100 can include at least one of the color or the reflectance (orintensity of reflected light) characteristics of the blood vessel.

An eye characteristic can include a body parameter of the patientassociated with the eye 100. A body parameter can include other metrics,such as chronological age and body mass index (BMI). A body parametercan include an indication of a fluid pressure applied to the eye 100,such as a fluid pressure applied to an anterior portion of the eye 100.A body parameter can include an indication of the cardiac cycle, such asan indication of heart rate, an indication of systemic blood pressure,such as systolic and diastolic pressures, or an indication ofspontaneous venous pulsation. An indication of the cardiac cycle caninclude at least one characteristic of an SVP, such as the frequency ofthe SVP, the change in vessel caliber due to the SVP, the phase of SVPrelative to systemic blood pressure, such as systemic systole anddiastole, the velocity of blood flow during SVP, or blood columnoscillation associated with SVP.

An eye characteristic can include a flow characteristic of the eye 100,such as a flow characteristic of a blood vessel of the eye 100. A flowcharacteristic of a blood vessel of the eye 100 can include at least oneof average or other central tendency of velocity of blood flow, such ascan be related to levels of IOP and CSF, systolic and diastolic velocityof blood flow, and density of blood flow. Flow characteristics of ablood vessel can change in a periodic fashion, for example, the flowcharacteristics can be related to the cardiac cycle. Flowcharacteristics in a blood vessel can be related to IOP, CSF, or bothIOP and CSF, such as flow velocities in a vessel can be affected bychanges in CSF. A flow characteristic can include a compositecharacteristic, such as an eye characteristic calculated from one ormore eye characteristics. Composite characteristics can include thepulsatility index (PI) and the resistivity index (RI). ICP can beestimated using a method, such as can include measuring venous outflowpressure, measuring central retinal arterial blood flow, and estimatingICP using the venous outflow data and at least one of a pulsatility orresistivity relationship.

The apparatus 200 can be used in or in combination with one or moresensing instruments 513 to apply fluid pressures, such as therapeuticpressures, to the eye 100. Applying therapeutic pressures to the eye 100can modify pressure indications associated with the eye 100, such asindications of physiological parameters, to treat one or more eyeconditions of the eye 100.

FIG. 2 shows an example of an apparatus 200, such as for applying fluidpressure to an external surface of the eye 100, such for at least one ofdiagnosing or treating an eye condition, such as can include an abnormaleye condition. Applying fluid pressures to the eye 100 can inducechanges in the eye 100, such as to change characteristics of the eye100, such as fluid pressures associated with the eye 100.

The apparatus 200 can include an goggle enclosure 210, a pump 220 influid communication with the goggle enclosure 210, a control circuit 230in electrical communication with the pump 220, and a locating device 240connected to the goggle enclosure 210. In an example, the apparatus 200can include one or more enclosures 210, such as to form a set of gogglesthat can be located over the eyes 100 of a patient for diagnosing ortreating for an eye condition. In an example, an image processor circuitcan include at least one of the control circuit 230 or a VAD imageprocessor circuit.

The apparatus 200 can provide adjustable control over IOP in a patienteye 100 such as to balance IOP with ICP or otherwise control TPD in thepatient eye 100 to treat an abnormal eye condition. In an example, anabnormal eye condition, such as glaucoma, can be treated by using thegoggles and pump for drawing a small vacuum to the external surface ofthe patient eye 100 in the goggle enclosure 210, such as a vacuum of10-15 mmHg relative to the surrounding ambient atmospheric pressureoutside of the goggles, such as to reduce IOP and balance TPD. In anexample, an abnormal eye condition, such as Vision Impairment andIntracranial Pressure (or VIIP), such as due to microgravity-inducedincreases in ICP, can be treated by applying a positive pressure to thesurface of the patient eye 100 in the goggle enclosure 210, such as toincrease ICP and balance TPD. VIIP can include a one or more of avariety of abnormal eye conditions, such as hyperopic shifts, scotoma,cotton wool spots, choroidal folds, optic nerve sheath distension, globeflattening, and optic nerve edema.

The goggle enclosure 210 can be sized and shaped to surround the patienteye 100, such as to be seated on an eye socket of the eye 100, and bespaced from the eye 100 without contacting the eye 100. The goggleenclosure 210 placed against the patient can include or define a cavity212 between the goggle enclosure 210 and the patient. The goggleenclosure 210 can extend about the eye 100, such as the entire exposedanterior portion of the eye 100. The goggle enclosure 210 can include aseal material 214, such as can be located around the perimeter of thegoggle enclosure 210. The goggle enclosure 210 can be positioned overthe eye 100, such that the seal material 214 can be located against thepatient, such as to form a gasket between the goggle enclosure 210 andthe patient. In an example, the goggle enclosure 210 can be locatedagainst the skin of the patient to form a gasket between the goggleenclosure 210 and the patient, such as to maintain a desired fluidpressure level within the enclosure using the pump. In an example, thegasket can form a hermetic seal, such as can include an airtight seal,between the cavity 212 and the surrounding environment.

The goggle enclosure 210 can be constructed of a material that can besufficiently rigid to support or maintain a differential fluid pressurebetween the cavity 212 and another region, such as the atmospheresurrounding the goggle enclosure 210 or another cavity 212. Thedifferential fluid pressure can include the difference between the fluidpressures in the cavity 212 and the fluid pressure of the ambientenvironment outside the goggle enclosure 210. A fluid pressure withinthe cavity 212 can act on the front surface of the eye 100, such as toapply a positive or negative force to the anterior portion of the eye100, without physically contacting the eye 100 with any non-gaseousfluid body or device, such as to influence TOP in a patient eye 100,such as to decouple TOP from ICP. The goggle enclosure 210 can beconstructed from an optically transparent material, such as to allow apatient to see outward through the goggle enclosure 210. The opticallytransparent material can also allow observation of the eye 100, such asfeatures of the intraocular space, inward through the goggle enclosure210, such as by a medical professional using a measurement instrument.

FIG. 3 shows an example of a goggle enclosure 210 including a port 320.The port 320 can act as a channel between the interior surface 216 andthe exterior surface 218 of the goggle enclosure 210, such as to allowfluidic communication between the cavity 212 and the atmospheresurrounding the goggle enclosure 210. The port 320 can allow one or moreobjects, such as one or more measurement instruments, to be insertedthrough the port 320, such as to locate the objects in proximity to theeye 100. The port 320 can be located on any surface of the goggleenclosure 210. A first sealing interface (e.g., valve or seal) can belocated between the measurement instrument and the port 320, such as toform a hermetic or other seal between the measurement instrument and theport 320. The first sealing interface can include one or more sealingstructures, such as one or more of a membrane, sleeve, O-ring, orbellows, such as can be made of one or more sealing materials, such asplastic, rubber, copolymer, or elastomeric materials.

The goggle enclosure 210 can include a stopper 322, such as can beinserted into the port 320 to inhibit or prevent gas or liquid or otherfluid from traveling between the cavity 212 and the atmospheresurrounding the goggle enclosure 210. A second sealing interface can belocated between the stopper 322 and the port 320, such as to form ahermetic seal between the stopper 322 and the port 320. The stopper 322can assume any volumetric shape, such as a volumetric shape that can beused in combination with the port 320 and the second sealing interfaceforms a hermetic seal. The stopper 322 can include a shape with at leastone tapered surface, such as a frustum of a cone or conic section, suchas the at least one tapered surface can be inserted into the port 320,the tapered surface forming a second sealing interface conformable withthe port 320, such as to form a hermetic seal. The stopper 322 canassume a shape that can be formed to the port 320 by the patient. In anexample, a quantity of a pliable or moldable material can be formed byhand for insertion into the port 320, such as to form the stopper 322and the second sealing interface conformable with the port 320. Thestopper 322 can be constructed from an optically transparent material,such as to allow a patient to see outward through the stopper 322. Thestopper 322 can include a surface covering device, such as a thin filmconfigured to be impermeable to gas, to cover the port 320. The surfacecovering device can include at least one adhesive surface, such as anadhesive surface configured to adhere to a surface of the goggleenclosure 210, such as at least one of the interior surface 216 orexterior surface 218 of the goggle enclosure 210.

FIG. 4 shows an example of a multi-part goggle enclosure 210. The goggleenclosure 210 can include a base 424 and a cap 426 that can join withthe base 424 at an interface 428. The base 424 can be sized and shapedto surround the eye 100 and be spaced from the eye 100 withoutcontacting the eye 100. The base 424 can include or define a portion ofone or more enclosed cavities 212 when placed against the patient, suchas against the eye socket of the eye 100. The base 424 can include aseal material 214, such as can be located around a perimeter of the base424. The base 424 can be positioned over the eye 100, such that the sealmaterial 214 can be located against the skin of a user, such as to forma gasket between the base 424 and the skin. The base 424 can be securedto a patient, such as to maintain the location of the base 424 over theeye of the patient, such as with at least one of a locating strap, suchas a locating strap connected to the base 424 and configured togenerally encircle the head of the patient, or an adhesive, such as anadhesive applied to the interface between the base 424 and the patient.

The cap 426 can attach to the base 424, such as at the interface 428, toform the goggle enclosure 210, such as to define the cavity 212 withinthe goggle enclosure 210. The cap 426 can include a port 320, such as tolocate one or more objects such as can include one or more measurementinstruments (or portions thereof) in proximity to the eye 100. Ameasurement instrument can be attached to the cap 426, such as to bringa distal portion of the measurement instrument in proximity to the eye100. In an example, a measurement instrument can be attached to the cap426 such as by removing the stopper 322 from the port 320, inserting atleast a portion of the measurement instrument into the port 320, andattaching the measurement instrument to the cap 426. The measurementinstrument can be attached to the cap 426 such as to create a hermeticseal between the measurement instrument and the cap 426, such as withone or more of a threaded connection, a friction connection, or afastened connection such as can include one or more fastening devicesextending between the base 424 and the cap 426. The one or moremeasurement instruments can be integral to or attached to the cap 426,for example, the measurement instrument can be permanently affixed tothe cap 426.

The interface 428 can include the junction between the base 424 and thecap 426. In an example, the cap 426 can join with the base 424 at theinterface 428, such as to form the goggle enclosure 210. The interface428 can form a hermetic seal between the base 424 and the cap 426, suchas to support or maintain a differential fluid pressure between thecavity 212 and another region, such as the atmosphere surrounding thegoggle enclosure 210 or another cavity 212. The interface 428 caninclude a tongue-and-groove joint seal, where the tongue-and-groovejoint seal can include a tongue feature integral to the base 424, agroove feature integral to the cap 426, and a continuous seal component,such as an O-ring gasket, seated in the groove feature of the cap 426and configured to deform and seal against the cap 426 when impinged uponby the tongue feature of the base 424, such as to create the goggleenclosure 210. The interface 428 can include a the tongue-and-groovejoint seal including a tongue feature integral to the cap 426, a groovefeature integral to the base 424, and a continuous seal component, suchas an O-ring gasket, seated in the groove feature of the base 424 andconfigured to deform and seal against the base 426 when impinged upon bythe tongue feature of the cap 426, such as to create the goggleenclosure 210.

The goggle enclosure 210 can affect visualization of the eye 100 by themeasurement instrument, such as by changing the focus between the eye100 and the measurement instrument. The focus between the eye 100 andthe measurement instrument can be assisted or corrected, such as using acorrection lens that can include at least one of a converging lens, adiverging lens, or a combination of both. The correction lens can belocated between the eye 100 and the measurement instrument, such asbetween the eye 100 and the goggle enclosure 210, or between the goggleenclosure 210 and the measurement instrument. The correction lens can beattached to the goggle enclosure 210, such as at the interior surface216, the exterior surface 218, or both. The correction lens can beintegrated into the goggle enclosure 210, such as to form part of thestructure of the goggle enclosure 210. A correction lens can beintegrated into the cap 426, such as to allow a medical professional orother user the opportunity to select an appropriate correction factorfor use with a given measurement instrument.

Referring again to FIG. 2, the pump 220 can be in fluid communicationwith the cavity 212 of the goggle enclosure 210, such as through a tube222. The pump 220 can affect one or more physical characteristics of theenvironment of the cavity 212, such as the humidity, the temperature, orthe fluid pressure of the environment.

The pump 220 can apply and adjust fluid pressures, such as positive ornegative gauge pressures, in the cavity 212 of the goggle enclosure 210,such as to generate a force on the eye. A gauge pressure can include alocalized pressure in the cavity 212, referenced from atmosphericpressure outside of the cavity in its immediate surroundings, such as anatmospheric fluid pressure. A positive gauge pressure can include afluid pressure in the cavity 212 that is greater than atmosphericpressure. A positive gauge pressure in the cavity 212 can exert a forceto increase pressure on the anterior portion of the eye 100 relative tothe TOP in the eye 100, such as to increase the TOP of the eye 100. Anegative gauge pressure can include fluid pressure in the cavity 212that is less than atmospheric pressure. A negative gauge pressure in thecavity 212 can exert a force to decrease pressure on the anteriorportion of the eye 100 relative to the TOP in the eye 100, such as todecrease the TOP of the eye 100.

The pump 220 can include one or more devices that can be selected toapply a gauge pressure to the cavity 212 of the goggle enclosure 210.The pump 220 can include one or more of a compressor pump, a vacuumpump, or a reversible pump, such as to allow the pump 220 to create apositive or negative gauge pressure in the goggle enclosure 210. Thepump 220 can include a reservoir, such as to contain a positive ornegative gauge pressure, to apply a gauge pressure to the cavity 212such as without requiring continuous operation of the pump 220. In anexample, the pump 220 can operate for a period of time, such as tocreate a working gauge pressure in the reservoir, and then turn off fora period of time, such as until the gauge pressure in the reservoircrosses a threshold gauge pressure, to maintain the working gaugepressure in the reservoir. The pump 220 can include a reservoir, such asto contain a positive gauge pressure, and a venturi valve, such as incommunication with the reservoir and the cavity 212, to generate anegative gauge pressure in the cavity 212, such as by releasing gaseousfluid from the positive gauge pressure reservoir through the venturivalve to create a vacuum including a negative gauge pressure in thecavity 212.

The pump 220 can include a controllable vent in fluid communication withthe cavity 212, such as to adjust the gauge pressure within the goggleenclosure 210. The controllable vent can include a valve, such as toregulate the flow of gaseous fluid between the cavity 212 and thesurrounding environment, and an actuator connected to the valve and thecontrol circuit 230, such as to open and close the valve in response toa command signal sent from the control circuit 230, such as required tomaintain a desired gauge pressure within the cavity 212.

The pump 220 can apply pressures, such as positive or negative gaugepressures delivered to the goggle enclosure 210, to generate a force onthe eye. The appropriate duration of gauge pressures applied to the eyecan vary depending on the eye condition treated.

Diagnostic regimens, such as for diagnosing eye conditions, such asabnormal eye conditions, can require application of gauge pressuresdelivered by the pump 220 to the cavity 212 for relatively short periodsof time, such as for periods of time measured in seconds or minutes. Inan example, a procedure to diagnosis an abnormal eye condition, such asan acute or a chronic abnormal eye condition, such as glaucoma and opticdisc edema, can include application of gauge pressures with theapparatus 200 for at least one of 1 second, 2 seconds, 3 seconds, 4seconds, 5 seconds, 6 seconds, 7 seconds, 8 seconds, 9 seconds, 10seconds, 11 seconds, 12 seconds, 13 seconds, 14 seconds, 15 seconds, 16seconds, 17 seconds, 18 seconds, 19 seconds, 20 seconds, 21 seconds, 22seconds, 23 seconds, 24 second, 25 seconds, 26 seconds, 27 seconds, 28seconds, 29 seconds, 30 seconds, 31 seconds, 32 seconds, 33 seconds, 34seconds, 35 seconds, 36 seconds, 37 seconds, 38 seconds, 39 seconds, 40seconds, 41 seconds, 42 seconds, 43 seconds, 44 seconds, 45 seconds, 46seconds, 47 second, 48 seconds, 49 seconds, 50 seconds, 51 seconds, 52seconds, 53 seconds, 54 seconds, 55 seconds, 56 seconds, 57 seconds, 58seconds, 59 seconds, 60 seconds, 1 minute, 2 minutes, 3 minutes, 4minutes, 5 minutes, 6 minutes, 7 minutes, 8 minutes, 9 minutes, 10minutes, or more than 10 minutes.

Therapeutic regimens for acute eye conditions can require application ofgauge pressures delivered by the pump 220 to the cavity 212 forrelatively short periods of time, such as for periods of time measuredin minutes, hours, days, or weeks. In an example, a therapeutic regimento treat an acute eye condition, such as glaucoma and optic disc edema,can include application of gauge pressures with the apparatus 200 for atleast one of 1 hour, 2 hours, 3 hours, 4 hours, 5 hours, 6 hours, 7hours, 8 hours, 9 hours, 10 hours, 11 hours, 12 hours, 13 hours, 14hours, 15 hours, 16 hours, 17 hours, 18 hours, 19 hours, 20 hours, 21hours, 22 hours, 23 hours, and 24 hours, 1 day, 2 days, 3 days, 4 days,5 days, 6 days, and 7 days, 1 week, 2 weeks, 3 weeks, or 4 weeks.

A therapeutic regimen for acute eye conditions can require applicationof gauge pressures for intermittent intervals of time, such as periodicor aperiodic intervals. A periodic regimen can include applyingtherapeutic pressures periodically, such as on a diurnal cycle includingapplying therapeutic pressures generally during the night, untilresolution of the acute eye condition. An aperiodic regimen can includeapplying therapeutic pressures aperiodically, such as applyingtherapeutic pressure when an indication of physiological parameterincluding TOP falls outside a specified range and discontinuingtherapeutic pressure when the indication of the physiological parameterfalls within a desired level or range.

Therapeutic regimens for chronic eye conditions, such as glaucoma oroptic disc edema, can require application of gauge pressures deliveredby the pump 220 to the cavity 212 for relatively long periods of time,such as for periods of time measured in days, weeks, months or years. Inan example, a therapeutic regimen to treat a chronic eye condition, suchas glaucoma and optic disc edema, can include application of gaugepressures with the apparatus 200 for at least one of 1 day, 2 days, 3days, 4 days, 5 days, 6 days, and 7 days, 1 week, 2 weeks, 3 weeks, and4 weeks, 1 month, 2 months, 3 months, 4 months, 5 months, 6 months, 7months, 8 months, 9 months, 10 months, 11 months, and 12 months, 1 year,2 years, 3 years, 4 years, 5 years, 6 years, 7 years, 8 years, 9 years,or 10 years. In an example, a therapeutic regimen to treat a chronic eyecondition, such as glaucoma and optic disc edema, can include theapplication of gauge pressure delivered to the eye with the apparatus200 for the lifetime of the patient.

A therapeutic regimen for chronic eye conditions can require applicationof gauge pressures for intermittent intervals of time, such as periodicor aperiodic intervals. A periodic regimen can include applyingtherapeutic pressures periodically, such as on a diurnal cycle includingapplying therapeutic pressures generally during the night to restoreaxonal transport, for the lifetime of the patient. An aperiodic regimencan include applying therapeutic pressures aperiodically, such asapplying therapeutic pressure when an indication of a physiologicalparameter including TOP falls outside a specified range anddiscontinuing therapeutic pressure when the indication of thephysiological parameter falls within a desired level or range.

The pump 220 can modulate the gauge pressures applied to the one or moreenclosures, such as periodically and aperiodically. A periodic gaugepressure can include gauge pressures that vary in magnitude at regularintervals, such as with sinusoidal signals, periodic non-sinusoidalsignals, and repeating processes. In an example, the gauge pressureapplied to the goggle enclosure 210 can vary in a substantiallysinusoidal fashion with a period of approximately 24-hours, such as tocompensate for the natural diurnal cycle of TOP in the eye 100 of thepatient. A periodic gauge pressure can include gauge pressures that varyin frequency, such as the time between repeating intervals in theperiodic signal. In an example, the gauge pressure applied to theenclosure can vary in frequency, such as when the gauge pressure appliedto the cavity 212 can vary as a function of cardiac activity, such asheart rate and blood pressure, the cardiac activity measured by adetection device, such as a blood pressure monitoring device.

An aperiodic gauge pressure can include gauge pressures that vary inmagnitude at irregular intervals, such as non-periodic signals andnon-repeating processes. The gauge pressure applied to the enclosure canvary in an aperiodic fashion that is dependent upon an indication of abody parameter, such as the position of a patient with respect to acoordinate system, the position of the patient measured by aninclinometer. In an example, an indication of a body position caninclude a change in body position, such as the change in body positionof a patient transitioning from a first body position, such as astanding position, to a second body position, such as a sitting or proneposition. The gauge pressure applied to the goggle enclosure 210 canvary in an aperiodic fashion that is dependent upon the summation of oneor more periodic and aperiodic signals. In an example, the gaugepressure applied to the goggle enclosure 210 can include a periodiccomponent, such as the gauge pressure due to cardiac activity, and anaperiodic components, such as the gauge pressure due to the bodyposition of a patient.

The control circuit 230 can coordinate operation of the apparatus 200,such as the application of fluid pressure to the cavity 212. The controlcircuit 230 can include a central processor unit (CPU), such as amicrocontroller or a microprocessor running one or more programs oralgorithms, memory, such as cache memory, a data interface 232, such asincluding one or more input channels, such as to receive one or moredata input signals from one or more components of the apparatus 200, adata output channel, such as to transmit an indication of a processeddata signal to another component of the apparatus 200, and a userinterface (UI), such as a UI designed to receive an indication of a datainput signal, such as information derived from a user interaction withthe apparatus 200, and display an indication of a data output signal,such as information regarding operating parameters or conditions of theapparatus 200. The CPU can process one or more data input signals, suchas to form a data output signal including a processed composite signal.The control circuit 230 can be used in a control system, such as afeedback control system, to operate or enhance performance of theapparatus 200, such as for at least one of a diagnostic or therapeuticapplication.

The locating device 240 can secure the goggle enclosure 210 to thepatient, such as to maintain the location of the goggle enclosure 210over the eye 100 of the patient. The locating device 240 can beadjustable, such as to conform with the specific anatomy of the patient.The locating device 240 can include an adjustable strap. The locatingdevice 240 can be integral to the goggle enclosure 210, such as thelocating device can be permanently attached to the goggle enclosure 210.The locating device 240 can include an adhesive, such as an adhesiveapplied to the goggle enclosure 210 and located between the goggleenclosure 210 and the skin of the patient, to attach the goggleenclosure 210 to the skin of the patient. The adhesive can include anymaterial suitable to maintain a seal, such as a hermetic seal, betweenthe cavity 212 and the surrounding environment, such as an adhesiveapproved for use on skin including a medical grade adhesive.

FIG. 5 shows an example of a feedback control system 500. The feedcontrol system 500 can be used to control, such as modify, the behaviorof the apparatus 200. The feedback control system 500 can include agoggle enclosure 210, a pump 220, a control circuit 230, an enclosuresensor 506, and a detector device 508.

The goggle enclosure 210 can cover the eye 100. An eye characteristic ofthe eye 100 can be described by an eye parameter 502. The eye parameter502 can be detected by a detector device 508, such as to convert the eyeparameter 502 into an electrical signal that can represent an indicationof the eye parameter 502, such a detected eye parameter signal 510. Theenclosure pressure parameter 505 can be detected by an enclosurepressure sensor 506, such as to convert the enclosure pressure parameter505 into an electrical signal that can represent an indication of theenclosure pressure parameter 505, such as a detected enclosure pressureparameter 507. A data interface 232 can receive signals, such as atleast one of a detected eye parameter signal 510, a target eye parametersignal 512, or a detected enclosure sensor signal 507. A target eyeparameter signal 512 can include an electrical signal representing anindication of a target eye parameter, such as a target value of an eyecharacteristic. The data interface 232 can be in communication, such aselectrical communication, with the control circuit 230. The controlcircuit 230 can receive the signals from the data interface 232, processthe signals from the data interface 232, such as to form a pump controlsignal 501, and transmit an indication of the pump control signal 501 tothe pump 220. The pump 220 can operate in response to the pump controlsignal 501, such as to generate a fluid pressure level 503, for deliveryto the goggle enclosure 210.

FIG. 6 shows examples of detector devices 508 that can be used in or incombination with the apparatus 200. A detector device 508 can include apressure sensor or other device that can detect a direct measurement ofan intrabody pressure, such as at least one of intraorbital pressure,ICP, IOP, or a relationship between ICP and IOP, such as throughdetection of a parameter related to at least one of an intraorbitalpressure, ICP or IOP. In an example, the relationship between ICP andIOP can include an indication of at least one of SVP, a cup-to-discratio, a change in radius of curvature of the eye 100, such asflattening of the posterior globe, or a change in axial length of theeye 100, such as a change in the distance between an anterior surface ofthe eye 100 and a posterior surface of the eye 100. The sensor system508A can be implanted or located within the humor of the eye 100, suchas the viscous or aqueous humor, or anchored to an interior surface ofthe eye 100. The sensor system 508A can be configured to be used in orin combination with an intraocular lens, such as a stand-alone sensor inproximity to an intraocular lens, or as a sensor integrated into areplacement intraocular lens and implanted into the eye 100, such asduring cataract surgery.

The sensor 508A can include a passive sensor or non-powered sensor, suchas a manometer sensor system. The manometer sensor system can include amanometer pressure sensor and a manometer data receiver. The manometerpressure sensor can include a sensing device, such as a sensing devicethat can be integrated into an implantable ocular replacement lens andimplanted within the intraocular space, such as the manometer pressuresensor can be visible through the cornea. The manometer pressure sensorcan include a meniscus, such as an interface between at least twoworking fluids of the manometer. In an example, the meniscus can belocated at a first level, such as when subjected to a first fluidpressure including a first TOP, and located at a second level, such aswhen subjected a second fluid pressure including a second TOP, such asthe first and second fluid pressures are different.

The manometer data receiver can include an imaging device, such as a VAD509. The VAD 509 can include a camera system 509E, such as at least oneof a fundus camera, a video camera, or a smartphone camera. The camerasystem 509E can be attached to a frame, such as the goggle enclosure210. The camera system 509E can be located in proximity to the patienteye 100, such as to establish a clear line of sight between the camerasystem 509E and the manometer pressure sensor, such as to be visiblethrough the cornea. For example, the imaging device can include or besimilar to one or more of a commercially available device, such thedevice from Apple Inc. (Cuppertino, Calif.) offered for sale under thetrademark GOOGLE GLASS®. In an example, the camera system 509E can belocated in the cavity 212 of the goggle enclosure 210, such as with thecamera directed towards the eye 100 and configured to focus andvisualize the pressure display indicator of the sensor, such as themeniscus of the manometer pressure sensor.

The sensor 508A can include an active or powered sensor, such as awireless transmitting sensor system. The system can include a pressuretransducer and pressure transducer local interface. The pressuretransducer can include at least one of a battery-powered sensor or atranscutaneously-powered transducer, such as can be implanted within theintraocular space to detect an indication of an eye characteristic, suchas IOP. The pressure transducer local interface can be in electricalcommunication with the pressure transducer, such as to wirelesslytransmit energy to the pressure transducer, such as to power thepressure disk sensor, and wirelessly receive data from the pressuretransducer, such as an indication of IOP. For example, the sensor 508Acan include or be similar to one or more of the eye pressure measurementsystem and devices from Implandata Ophthalmic Products GmbH (Hannover,Germany) offered for sale under the trademark EYEMATE®. In an example,the pressure transducer local interface can be integrated into theapparatus 200, such as located in the goggle enclosure 210. The goggleenclosure 210 can locate the pressure transducer local interface inproximity to the pressure transducer, such as to allow for wirelesscommunication between the pressure transducer and the pressuretransducer local interface.

The detector device 508 can include a direct ICP sensor 508B, such as todetect an indication of ICP, such as by direct exposure to ICP. Thesensor 508B can be located within or in communication with a portion ofthe body exposed to ICP, such as a ventricle of the brain or the spinalcord. The sensor 508B can include a powered ICP sensor, such as at leastone of a battery-powered sensor or a transcutaneously-powered sensor,such as can be at least partially implanted within the body to sense anindication of ICP, and an indicator capture device, such as a device towirelessly collect data about the indication of ICP from the poweredsensor. For example, the sensor 508B can include or be similar to one ormore of the devices and methods described in the paper “Laboratorytesting of the Pressio intracranial pressure monitor”, by Allin, et al.,published in Neurosurgery, Vol. 62, #5, May 2008, p. 1158. In anexample, the sensor 508B can be implanted in the patient, such as aventricle of the brain through a surgical approach, and connectedelectrically to the control circuit, such as through the data interface232.

The detector device 508 can include a device that detects an indirectmeasurement of an intrabody pressure, such as at least one ofintraorbital pressure, ICP, TOP, or a relationship between ICP and TOP,such as through detection of a parameter related to at least one of anintraorbital pressure, ICP or TOP.

The detector device 508 can include an indirect TOP sensor, such as atonometer 508C, or other such device that can detect an indication ofTOP through detection of an indication related to TOP. Applanationtonometry can infer TOP based upon the applied force needed to flatten(or applanate) a portion of the cornea. An applanation tonometer caninclude a non-contact tonometer, such as an air-puff tonometer or anocular response analyzer. An applanation tonometer can include a contacttonometer, such as a Goldmann tonometer, a Perkins tonometer, a dynamiccontour tonometer, an electronic indentation tonometer, a reboundtonometer, a pneumatonometer, an impression tonometer, a non-cornealtonometer, or a transpalpebral tonometer.

FIG. 7 shows an example of a tonometer 508C included in or used incombination with an example of an apparatus 200. The goggle enclosure210 of the apparatus 200 can include a port 320 through which a portionof the tonometer 508C can extend, such as to locate such portion of thetonometer 508C in close proximity to the eye 100. The port 320 caninclude a valve or sealing interface, such as to form enough of ahermetic seal between the port 320 and the tonometer 508C, so that agauge pressure can be maintained within the cavity 212 of the goggleenclosure 210 while operating the tonometer 508C to measure the TOP ofthe eye 100. The tonometer 508C can include a contact tonometer, such asa rebound tonometer including the rebound tonometer device from IcareFinland Oy (Espoo, Finland) offered for sale under the trademark ICARE™.

The tonometer 508C can include a non-contact tonometer, such as an airpuff tonometer. The air puff tonometer can include an actuating element,such as can provide a jet of pressurized air applied to the surface ofthe eye 100. When used in or in combination with the apparatus 200, suchas an apparatus 200 with a cavity 212 at a first fluid pressure, the airpuff tonometer can be configured to generate a jet of pressurized air,such as a jet of pressurized air at a second fluid pressure that can beselected relative to (e.g., to be greater than) the first fluid pressureapplied to the cavity 212, such as to applanate the eye 100 in thepresence of the first fluid pressure applied to the cavity 212. Forexample, the tonometer 508C can include or be similar to the air pufftonometer device from Topcon Medical Systems Incorporated (Oakland,N.J., USA) offered for sale under the trademark CT-80 NON-CONTACTCOMPUTERIZED TONOMETER™. In an example, the goggle enclosure 210 canintegrate with the CT-80, such as to locate the measuring nozzle andmeasuring window within the goggle enclosure 210.

The detector device 508 can include an eye surface sensor system 508D,such as a device that can be in substantial contact with the eye 100,such as the scleral or corneal surface of the eye 100. The eye surfacesensor 508D can measure a deformation of the surface of the eye 100.Such deformation can be correlated to an indication of an intrabodypressure, such as TOP. The eye surface sensor system 508D can beincluded in, or used in combination with a contact lens, such as acorrective or cosmetic contact lens. The eye surface sensor 508D caninclude a wirelessly powered microsensor device attached to a contactlens-type device, such as to detect one or more circumferential changesof the surface of the eye 100, such as due to changes in one or moreintrabody pressures of the eye 100, such as can include IOP. The eyesurface sensor 508D can include an indicator capture device, such as anantenna or other transmitter and an indicator capture interface circuit,such as can include a receiver to wirelessly collect information aboutone or more indications of one or more eye characteristics of the eye100 sensed from the eye surface sensor. For example, the eye surfacesensor system 508D can include or be similar to a contact lens-baseddetection system device from Sensimed AG (Lausanne, Switzerland) offeredfor sale under the trademark SENSIMED TRIGGERFISH®. In an example, theindicator capture interface circuit can be integrated into the apparatus200, such as located in the goggle enclosure 210. The goggle enclosure210 can locate the indicator capture interface circuit in proximity tothe pressure transducer, such as to allow for wireless communicationbetween the indicator capture device and the indicator capture interfacecircuit.

The detector device 508 can include or be used in combination with anoptical signature sensor system 508E, such as can include an implantdevice that can be located within the eye 100, such as in at least oneof the aqueous or viscous humor, and a detector unit. The implant devicecan include a sensor, such as can include a pressure-sensitivenanophotonic structure. The detector unit can be integrated into thegoggle enclosure 210, such as in proximity to the implant device, suchas in a direct line of sight with the implant device. The detector unitcan include an energy source such as can excite the implant device, suchas with electromagnetic energy, such as from at least one of theultraviolet, visible, or near infrared frequency ranges, and receivereflected electromagnetic energy from the implant device. The receivedreflected electromagnetic energy can include an indication of an eyeparameter, such as IOP. The received reflected electromagnetic energycan be processed by a sensor interface control circuit, such as todetect one or more changes in the optical signature of the light, suchas due to a change in the IOP of the eye 100.

The detector device 508 can include a blood pressure sensor system 508F,such as can include a device that can detect one or more indications ofblood pressure, such as by at least one of auscultation, oscillometric,or photoplethysmography (or PPG) detection. An indication of bloodpressure can include one or more indications of one or more cardiaccycle blood pressure parameters, such as can include systolic pressure,diastolic pressure, orbital pressure, or episcleral venous pressure, andone or more related parameters, such as heart rate. Orbital pressure caninclude the pressure, such as the contact pressure, between the eye 100and the eye socket, such as the bones that form the eye socket, such asthe frontal, lacrimal, ethmoid, zygomatic, maxillary, palatine, andsphenoid bones.

An auscultation device can be included and used to detect one or moresounds originating from within the body, such as can be generated by thecardiac cycle including at least one of heart beat or blood flow inblood vessels. An auscultation device can include at least one of astethoscope, such as an acoustic or electronic stethoscope, or astethoscope used in or in combination with a sphygmomanometer, such as amercury or aneroid sphygmomanometer.

An oscillometric device can be included and used to detect vibration ina blood vessel, such as vibration due to flow of blood in a bloodvessel. An oscillometric device can include one or more sensors, such asat least one of an electrostatic sensor or a capacitive sensor, and canbe located in in contact with or in proximity to the patient, such as todetect vibration, such as due to blood flow in a blood vessel of thepatient.

A PPG device can be included and used to detect reflectance of light,such as from the skin of a patient. A PPG device can include a lightradiation source, such as a source of light that can irradiate the skinof a patient, and a light radiation receiver, such as a receiver toreceive reflected light from the skin of the patient. The lightradiation source can generate light at a selected wavelength, or atdifferent wavelengths, such as at least one of a green light, such aswith a wavelength of about 525 nanometers, or an infrared light, such aswith a wavelength of about 800 nanometers. For example, the PPG devicecan include or be similar to the device from Apple Inc. (Cuppertino,Calif.) offered for sale under the trademark APPLE WATCH®. In anexample, the APPLE WATCH can be in electrical communication with theapparatus 200, such as through a wireless interface communicating withthe control circuit 230.

The detector device 508 can include an inclinometer sensor 508G. Aninclinometer sensor 508G can provide an indication of an eye parameter,such as an indication of one or more hydrostatic pressures associatedwith the eye 100, such as a differential hydrostatic pressure. Theinclinometer sensor 508G can include a combination of sensors, such asat least one of a tilt sensor, an accelerometer, a multi-axisinclinometer, or a multi-axis accelerometers. The inclinometer sensor508G can indicate a patient's relative position with respect to a moreglobal reference frame, such as the ground. In an example, aninclinometer sensor 508G can indicate an angle of 0 degrees when thepatient is standing upright relative to the ground (e.g., the patient isperpendicular to the ground) and an angle of 90 degrees when the patientis lying down (e.g., the patient is parallel to the ground). Theinclinometer sensor 508G can indicate the patient's relative positionwith respect to a local reference frame, such as an anatomical referenceframe, such as can include sagittal, coronal, and transverse planes. Inan example, an inclinometer sensor 508G can indicate an angle of 0degrees when the patient is in a supine position (e.g., lying down, faceup) and an angle of 180 degrees when the patient is in a prone position(e.g., lying down, face down).

The detector device 508 can include a color/intensity sensor system508H. A color/intensity sensor system can include an imaging system,such as a visualization assistance device 509, such as a camera system509E, and a color/intensity processing software, such as running on theCPU of the control circuit 230. In an example, the camera system 509Ecan perform a visualization of a portion of the eye 100, such as a firstand subsequent visualizations, that can include information about anindication of at least one of color or color intensity, such as adigital image. The camera system 508E can digitize an image, such as afirst and subsequent digital images, such as for processing, andtransmit the digitized image, such as to the control circuit 230. Thedifference between an indication, such as an indication of at least oneof color or color intensity, can be determined, such as with at leastone of a comparator circuit or a color/intensity processing software,such as between a first and subsequent digital image, and the differencebetween the indication stored, such as with an electronic storagedevice.

The detector device 508 can include a pressure sensor, such as a cavitypressure sensor 508I, to detect fluid pressure, such as in a confinedvolume. The cavity pressure sensor 508I can include a sensing elementsuch as can include at least one of a piezoelectric material, apiezoresistive material, a capacitive material, such as a sensor basedon the Hall effect, or a resistive material, such as a strain gaugesensor.

The detector device 508 can include a pressure sensor, such as a contactpressure sensor system 508J, to detect one or more surface pressures.The contact pressure sensor system 508I can include a contacttransducer, such as at least one of piezoresistive, piezoelectric,capacitive, optical, potentiometric, or electromagnetic sensing element,and a wireless signal interface, such as to power the contact transducerand detect signals from the transducer. The contact pressure sensor 508Ican include at least one of a strain sensor or a capacitive mat. Thecapacitive mat can include a first conductive member, a secondconductive member in proximity to the first conductive member, and aninsulating member, such as a dielectric material located between thefirst and second conductive members. As the first conductive memberapproaches the second conductive member, such as due to the influence ofopposing contact forces, such as forces generated between the sclera 122and the eye socket, a change in capacitance between the first and secondconductive members can be detected, such as a change proportional to thedistance between the first and second conductive members. The contactpressure sensor system 508J can detect an indication of blood pressure,such as by detecting an indication of a contact pressure between twosurfaces, such as variations in force due to systolic and diastolicpressure. The contact pressure sensor system 508J can be placed betweenthe sclera 122 and the eye socket, such as to detect orbital pressure.Orbital pressure can include one or more forces applied by the eye 100to the eye socket due to blood pressure in the eye 100, such as can varyin time, such as due to systolic and diastolic blood pressures.

FIG. 8 shows examples of a visualization assistance device 509 (or VAD)that can be included in or used in combination with the apparatus 200,such as to help perform a visualization of the patient eye 100. The VAD509 can visualize a portion of the eye, such as at different fluidpressures within the enclosure, such as to monitor an indication of aneye characteristic. A visualization can include a representation of aphysical structure, such as at least one of an indication of a physicalstructure of the patient eye 100 or an indication of an eyecharacteristic of the patient eye 100, such as an image including ananalog or digital image. The image can be undocumented, such as theimage can be perceived by a human observer without storing the image,such as to computer memory. The image can be documented, such as theimage can be perceived and stored, such as to computer memory, by anobserver with the use of an imaging device, such as a VAD 509

The VAD 509 can include a system that can receive an image, such as witha visualization detector, and convert the received image to a signal,such as a received electrical signal. The received electrical signal caninclude an array of discrete values, such as pixels and voxels,representing the received image, such as a digital image. The VAD 509can process, such as digitally process, a visualization, such as one ormore images, with an image processor circuit, such as a VAD processorcircuit, such as a VAD processor circuit integral to the VAD 509.

The VAD 509 can include a lens or other device to help a humanobserver's eye to detect an indication of an eye parameter, such as acup-to-disc ratio of a patient eye 100. The eye of an observer candetect a change of an indication of a physiological parameter, such asby comparing a first cup-to-disc ratio of a patient eye 100 due to afirst gauge pressure applied to the patient eye 100 with the apparatus200 to a second cup-to-disc ratio of a patient eye 100 due to a secondgauge pressure applied to the patient eye 100 with the apparatus 200,such as the observer can estimate the change in the indication of thephysiological parameter due to the change in pressure applied by theapparatus 200. The VAD 509A can include one or more devices, such as atleast one of a magnifier, such as a bio-microscope, or anophthalmoscope, such as with a light source, to enhance detection of anindication of an eye characteristic.

The VAD 509 can include a magnetic resonance imaging (MRI) system 509B.The MRI system 509B can include an MRI visualization detector such ascan include one or more sensors that can detect radio frequency (RF)energy, such as energy in a frequency range from about 20 kilohertz toabout 300 megahertz. The MRI system 509B can be used create atwo-dimensional or three-dimensional image of the eye.

The VAD 509 can include an ultrasound system 509C. The ultrasound system509C can include an ultrasound visualization detector such as caninclude one or more sensors, such as at least one of a piezoelectrictransducer, a piezoelectric transceiver, or an array of piezoelectrictransducers and transceivers, that can detect ultrasonic energy, such asenergy in a frequency range from about 20 kilohertz to about tengigahertz.

The VAD 509 can include an optical coherence tomography (OCT) system509D. The OCT system 509D can include a visualization detector such ascan include one or more sensors, such as can include at least one of acharge coupled device (CCD) or a complementary metal-oxide semiconductor(CMOS) devices, to detect visible light, such as from an imaged object,and convert the light into electrical signals suitable for electronicstorage, such as in an array of pixels. In an example, axonal transportcan be imaged, such as with an OCT system 509D. In an example, an axonaltransport imaging device can include at OCT system 509D. In an example,a laminar cribrosa position or shape detection device can include an OCTsystem 509D. In an example, an OCT system 509D, such as a phase-varianceOCT system, can detect blood flow, such as change in blood flowvelocity, in a vessel.

The VAD 509 can include a camera system 509E. The camera system 509E caninclude at least one of a fundus camera, a video camera, or a smartphonecamera, such as a smartphone with video capture capability. In anexample, axonal transport can be imaged, such as with a fluoresceinangiography technique, such as by illuminating the retina of an eye 100,such as with light at a wavelength of 490 nanometers, and capturing theresulting image with a camera system 509E. In an example, an axonaltransport imaging device can include a camera system 509E.

The VAD 509 can include an X-ray system 509F, such as to detect energyat one or more frequencies greater than visible light, such as in afrequency range greater than about 300 terahertz, and convert the energyinto electrical signals suitable for recording, such as in an array ofpixels. In an example, an imaging device can include at least one of anX-ray computed tomography (X-ray CT) or a computerized axial tomography(CAT) system.

FIG. 9 shows an example of a method 900 for using the apparatus 200,such as to apply a fluid pressure to an eye 100 within the cavity 212 ofthe goggle enclosure 210. At 902, the apparatus 200 can receive datadirectly or indirectly indicating at least one of an intraorbitalpressure, ICP, IOP, or a relationship between ICP and IOP. The receiveddata can be detected from a patient, such as a patient wearing theapparatus 200 including an goggle enclosure 210 sized and shaped to beseated on an eye socket of an eye 100 to provide one or more cavities212 within the goggle enclosure 210 that extend about an entire exposedanterior portion of the eye 100. The apparatus 200 can receive data atthe control circuit 230, such as through the data interface 232, such asfrom a detector device 508 or a storage device, such as an electronicstorage device.

At 904, the apparatus 200 can, based on the received data as a feedbackcontrol variable, control the pump 220, such as to adjust a fluidpressure within the goggle enclosure 210 sized and shaped to be locatedover the patient eye 100 without contacting the patient eye 100, wherecontrolling the pump 220 can include further monitoring of the receiveddata to control the pump 220.

Receiving data directly indication at least one of an intraorbitalpressure, ICP, IOP, or a relationship between ICP and IOP, can includereceiving, such as from a detector device 508, an indication of a sensedIOP with a fluid pressure sensor previously implanted within anintraocular space of the eye, such as a direct IOP sensor system 508A.In an example, the manometer data receiver, such as the camera system509E, can receive a first image of a first manometer level at a firstpressure, such as at a CCD or CMOS device, and a second image of asecond manometer level at a second pressure. The camera system 508E candigitize the first and second images, such as for processing, andtransmit the digitized first and second images, such as to the controlcircuit 230. The difference between the first manometer level and thesecond manometer level can include an indication, such as a directindication, of the sensed IOP of the eye 100, such as due to the secondfluid pressure. In an example, the pressure transducer local interfacecan receive a signal, such as a wireless signal, from the pressuretransducer, such as implanted in the intraocular space of the patienteye 100. The pressure transducer local interface can digitize thewireless signal, such as for processing, and transmit the digitizedwireless signal, such as to the control circuit 232. The wireless signalcan include an indication, such as a direct indication, of the sensedIOP of the eye 100.

Receiving data directly indicating at least one of an intraorbitalpressure, ICP, IOP, or a relationship between ICP and IOP, can includereceiving, such as from a detector device 508, an indication of a sensedICP sensed by a fluid pressure sensor previously placed in fluidcommunication with a cerebrospinal region, such as the direct ICP sensorsystem 508B. In an example, the indicator capture device can receive asignal, such as a wireless signal, from the powered ICP sensor, such asimplanted in the ventricle of the brain of the patient eye 100. Theindicator capture device can digitize the wireless signal, such as forprocessing, and transmit the digitized wireless signal, such as to thecontrol circuit 230. The wireless signal can include an indication, suchas a direct indication, of the sensed ICP of the patient.

Receiving data directly indicating at least one of an intraorbitalpressure, ICP, IOP, or a relationship between ICP and IOP, can includereceiving, such as from a detector device 508, an indication of a sensedintraorbital pressure sensed by a sensor previously placed in fluidcommunication with an orbit of the skull, such as a contact pressuresensor system 508J. In an example, the contact pressure sensor system508J can include a capacitive mat. A signal, such as a signalproportional to orbital pressure, can be received, digitized, andtransmitted by the wireless signal interface to the control circuit 230.The wireless signal can include an indication, such as a directindication, of the sensed intraorbital pressure of the patient.

Receiving data indirectly indicating at least one of intraorbitalpressure, ICP, IOP, or a relationship between ICP and IOP, can includereceiving, such as from a detector device 508, an indication of at leastone of a systemic blood pressure, a differential hydrostatic pressure,or an orbital pressure, such as a sensor system including a wirelesssensor and a wireless sensor receiver. The sensor system can include atleast one of a blood pressure sensor system 508F and an inclinometersensor system (508G). In an example, the wireless sensor receiver canreceive a signal, such as a wireless signal, from the wireless sensor,such as in contact with the patient, such as the skin of the patient.The wireless sensor receiver can digitize the wireless signal, such asfor processing, and transmit the digitized wireless signal, such as tothe control circuit 230.

Receiving data indirectly indicating at least one of intraorbitalpressure, ICP, IOP, or a relationship between ICP and IOP, can includereceiving, such as from a VAD 509, an indication of displacement, suchas from a reference datum. An indication of displacement can include anindication of at least one of an eye characteristic, a translaminarpressure difference (TPD), such as a cup-to-disc ratio, an SVP, aninduced venous pulsation, or at least one of a lamina cribrosa shape orposition, such as referenced from a fixed datum. The sensor system caninclude an OCT system 509D. In an example, the OCT system can receive anindication of displacement, such as through detection of reflectedlight. In an example, the OCT system 509D can emit light, such as aspecific wavelength of light, receive reflected light, such as from adistant surface, with a detector, such as at least one of a CCD or CMOSdetector. The OCT system can digitize the detected reflected light, andtransmit the digitized signal, such as to the control circuit 230.

Receiving data indirectly indicating at least one of intraorbitalpressure, ICP, IOP, a relationship between ICP and IOP, can includereceiving, such as from a user, an indication of body parameter, such asat least one of a body mass index (BMI) and chronological age, such asto calculate an estimate of intraorbital pressure, ICP, IOP, or arelationship between ICP and IOP. In an example, the user interface (orUI) of the control circuit 230 can include a data input device, such asa keypad, such as to allow the control circuit 230 to receive data froma user. The received data can be stored, such as in RAM, such as for usein operation of the apparatus 200.

Receiving data indirectly can include receiving, such as from a detectordevice 508, an indication of an eye blood vessel characteristicincluding the caliber of a blood vessel, such as with an OCT system509D. The OCT system 509D can visualize a portion of the patient eye100, such as a portion including at least one blood vessel including avenous blood vessel, through the goggle enclosure 210, such as anenclosure constructed from an optically transparent material, while thepatient eye 100 can be subjected to a fluid pressure applied to thecavity 212 with the pump 220. Optical disturbances introduced by thegoggle enclosure 210 can be mitigated with the use of a correction lens,such as at least one of a correction lens placed between the OCT system509D and the goggle enclosure 210, a correction lens placed between thegoggle enclosure 210 and the patient eye 100, or a correction lensintegrated into the goggle enclosure 210.

The OCT system 509D can visualize changes in an indication of thecaliber of a blood vessel, such as changes in response to adjustingfluid pressure in the goggle enclosure 210. Adjusting fluid pressure inthe goggle enclosure 210 can cause the blood vessel to deform, such asto distend under decreasing fluid pressure in the goggle enclosure 210and collapse under increasing fluid pressure in the goggle enclosure210. The OCT system 509D can perform a visualization, such as one ormore visualizations, of the blood vessel, such as one or morevisualizations performed while adjusting fluid pressure in the goggleenclosure 210, and capture representations of the visualization, such asin a digital image.

The OCT system 509D can detect changes, such as in an indication of thecaliber of a blood vessel, such as by comparing a first digital image ofa portion of the patient eye 100, such as due to a first fluid pressurein the goggle enclosure 210, and a subsequent digital image of a portionof the patient eye 100, such as due to a subsequent fluid pressure inthe goggle enclosure 210, such as the first and subsequent fluidpressures are different. The OCT system 509D can determine an eyecharacteristic change criterion, such as collapse of a blood vesselvisualized in the patient eye 100, based on detected changes in anindication of the caliber of the blood vessel.

Analyzing can include detecting a change, such as a change identified bycomparing images, such as a first digital image due to a first fluidpressure and a subsequent digital image due to a subsequent fluidpressure, such as a subsequent fluid pressure sufficient to initiatecollapse of the blood vessel. Processing, such as image processing, caninclude using a comparator circuit. The comparator circuit can comparefirst and subsequent digital images, such as corresponding arrayelements in the digital images, such as at least one of pixels orvoxels. The comparator circuit can determine a difference, such asbetween the first and subsequent digital images, such as to identifychanges between a blood vessel characteristic of the first andsubsequent digital images.

Receiving data indirectly can include receiving, such as from a detectordevice 508, an indication of a translaminar pressure difference (TPD),such as an indication of a cup-to-disc relationship including acup-to-disc ratio. Visualizations of the cup-to-disc ratio can bereceived using a VAD 509, such as at least one of an MRI system 509B, anultrasound system 509C, an OCT system 509D, a camera system 509E, suchas a fundus, video, or smartphone camera 509E, or an X-ray system 509F.

The cup-to-disc ratio can indicate the relative magnitudes of IOP andICP in a patient eye 100, such as a ratio of IOP to ICP. Therelationship between IOP and ICP can be estimated, such as by acalibration of the cup-to-disc ratio of the eye 100, such as eachpatient eye 100, such as by varying applied fluid pressure levels in theapparatus 200, and performing visualizations of the eye 100, such as atthe varying applied fluid pressure levels. In an example, the IOP of apatient eye 100 can be varied, such as with the apparatus 200, byapplying incremental fluid pressure steps to the goggle enclosure 210,such as by incrementally increasing or decreasing fluid pressure in thegoggle enclosure 210. At each incremental fluid pressure step, avisualization of the cup-to-disc ratio can be performed, such as with atleast one of a VAD 509, and each visualization can be processed, such asby storing the visualization to a storage device. Assuming ICP remainsrelatively constant during the calibration, the relationship between IOPand ICP, such as the cup-to-disc ratio, can be identified from theincremental visualizations for the patient eye 100, such as byidentifying the cup-to-disc ratio of each visualization stored, andprocessed, such as by the control circuit 230, into a mathematicalequation, such as relating ICP to IOP, based on the data obtained duringthe calibration.

Controlling the pump 220 can include setting a therapeutic pressure inthe goggle enclosure 210, such as can include establishing the amount oftherapeutic pressure, or the therapeutic pressure level, to apply to thegoggle enclosure 210 to treat an abnormal eye condition. Establishingthe therapeutic pressure level can include processing a receivedindication of an eye characteristic, receiving a target value for theindication of the eye characteristic, determining the difference betweenthe received indication of the eye characteristic and the receivedtarget value of the indication of the eye characteristic, selecting atherapeutic pressure level based on the difference between the receivedindication of an eye characteristic and the received target values of anindication of the eye characteristic, and transmitting a control signalto a device operable to deliver the therapeutic pressure level to thegoggle enclosure 210, such as the pump 220.

Processing a received indication of an eye characteristic can includeassigning a value, such as a numerical value, to a received indicationof the eye characteristic. The numerical value of the receivedindication can include a value detected by a detector device 508 thathas been calibrated, such as with a calibration standard. In an example,the received indication of the eye characteristic, such as the IOP of aneye 100, can include the value of IOP detected with a detector device508, such as a rebound tonometer that has been calibrated with acalibration standard including at least one of a force standard or adisplacement standard. The numerical value of the received indication ofthe eye characteristic can be weighted, such as with a numerical factorto convert the received indication from a first set of parameter unitsto a second set of parameter units, such as with the CPU of the controlcircuit 230. In an example, the received indication can be received at afirst input channel of the control circuit 230 with a first set ofparameter units, such as millivolts or milliamps, and converted to asecond set of parameter units, such as pounds-per-square-inch (psi) ormillimeters of mercury (mmHg), by weighting the received indication witha numerical factor representing a conversion factor between the firstand second set of parameter units, such as mmHg per millivolt (mmHg/mv),with the CPU of the control circuit 230.

Processing a received indication of an eye characteristic can includecalculating a composite indication of an eye characteristic, such aswhere the composite indication can include a function of one or morereceived indications. The composite indication can be calculated with aprocessing unit, such as the CPU of the control circuit 230. In anexample, a composite indication of an eye characteristic, such as anindication of an estimate of TPD, can be calculated, such as by findingthe difference between a received indication of IOP and an estimate ofan indication of ICP, such as the estimate of an indication of ICP canbe a function of a received indication of blood pressure and one or moreindications of body parameters, such as BMI and chronological age.

Receiving a target value of an indication of an eye characteristic caninclude receiving at least one target eye parameter, such as one or moreindications of eye characteristics, and one and more indications of bodyparameters, such as from a user of the apparatus 200, such as from amedical professional prescribing use of the apparatus 200 to a patient,through the UI of the control circuit 230. In an example, a target eyeparameter can include a target value for TPD of the eye 100, such as atarget value in a range of about 2 mmHg to about 6 mmHg, including TPDtarget values of about 2 mmHg, about 3 mmHg, about 4 mmHg, about 5 mmHg,and about 6 mmHg. In an example, a target value can include a targetvalue for TOP of the eye 100, such as a target value in a range of about10 mmHg to about 20 mmHg, including IOP target values of about 10 mmHg,about 11 mmHg, about 12 mmHg, about 13 mmHg, about 14 mmHg, about 15 mmHg, about 16 mmHg, about 17 mmHg, about 18 mmHg, about 19 mmHg, andabout 20 mmHg. In an example, a target value can include one or moreindications of body parameters of the patient, such as BMI and patientage.

Receiving a target value of an indication of an eye characteristic caninclude calculating a composite target value of the indication of theeye characteristic, such as with the CPU of the control circuit 230,based upon received target values, such as one or more indications of aneye characteristic and one or more indications of the body parameters ofthe patient. In an example, a composite target value of an indication ofTPD can be calculated as the weighted sum of an indication of an eyecharacteristic, such as blood pressure, and one or more indications ofbody parameters, such as body-mass index (BMI), patient age, and one ormore experimental constant values related to one or more indications ofeye characteristics including one or more experimental constant valuesderived from a curve-fitting algorithm.

Receiving a target value of an indication of an eye characteristic caninclude receiving a target value profile, such as a list of targetvalues corresponding to discrete points in time, for one or moreindications of eye characteristics. The magnitude of the received targetvalues can vary with respect to time, such as periodically with time oraperiodically with time. In an example, a received target value profilecan include a list of target values for IOP where the magnitude of theIOP target values vary periodically, such as on a diurnal cycle or acycle that repeats approximately every 24-hour time period.

Determining the difference between the received indication of an eyecharacteristic and the received target value of the indication of theeye characteristic can include combining the received indication and thereceived target value with one or more mathematical operations, such asto form an error signal. The error signal can be used as a controlsignal, such as for the pump 220, to set a gauge pressure, such as atherapeutic pressure level, in the goggle enclosure 210. In an example,the error signal can include a value resulting from subtracting a valueof the received target value from a value of the received indicationwith the CPU of the control circuit 230.

A mathematical operation can include any numerical, symbolic, or logical(e.g., Boolean) operation applied to one or more numbers or one or morearrays of numbers, such as a time-based series of values representing anindication of a eye characteristic. Numerical operations can includeaddition, subtraction, multiplication, division, weighting, such as bymultiplying a number by a constant value to obtain a weighted value, andconversion by a function, such as converting a number to a logarithmicrepresentation of the number.

A device operable to deliver the therapeutic pressure level to thegoggle enclosure 210, such as the pump 220, can have one or moreoperating characteristics, such as power curve for an electric motorwhere the output power (e.g., a dependent variable) varies as a functionmotor speed (e.g., an independent variable). A control signal can begenerated, such as to incorporate the operating characteristics of thepump 220, to apply a therapeutic pressure level to the goggle enclosure210, such as by controlling the pump 220 with the control signal.

Selecting a therapeutic pressure level to apply to the goggle enclosure210 can include generating a control signal related to the therapeuticpressure level, such as by at least one of calculating a control signalor identifying a control signal. Calculating a control signal caninclude applying one or more mathematical operations to one or moresignals, such as received indications of eye characteristics and theerror signal. In an example, a control signal can include combining theerror signal and a function representing the operating characteristicsof the pump 220 with one or more mathematical operations, such as toform a pump control signal.

Identifying a control signal can include comparing the error signal toan array of control signal values, such as to identify a control signalrelated to the therapeutic pressure level. An array of control signalvalues can include a lookup table where there exists a functionalrelationship between an independent variable, such as the error signal,and a dependent variable, such as the control signal.

The functional relationship between and independent and dependentvariables can include a linear function of the independent variable togenerate the control signal. A linear function can include combinationsof mathematical operations applied to at least one of one or moreindications of eye characteristics or one or more body parameters, suchas where the dependent variable can be directly proportional to theindependent variables. In an example, the error signal can be multipliedby a system gain, such as a gain proportional to an indication of a eyecharacteristic, to realize a pump control signal that can operate thepump 220 to deliver the therapeutic pressure level required to treat theeye condition of the eye 100.

The functional relationship between and independent and dependentvariables can include a nonlinear function of the independent variableto generate the control signal. A nonlinear function can includecombinations of mathematical operations applied to at least one of oneor more indications of eye characteristics or one or more bodyparameters, such as where the dependent variable can be indirectlyproportional to the independent variables. A nonlinear function caninclude combinations of mathematical operations applied to one or moreindications of parameters exclusive from the patient, such as theoperating characteristics of a device including a frequency domain andtime domain characterizations of device operation. In an example, theerror signal can be weighted by a nonlinear function or parameter, suchas a function or parameter describing the operating characteristics ofthe pump 220 where the gauge pressure generated by the pump 220 can bedependent on the speed of the pump 220, to realize a control signal thatcan operate the pump 220 to deliver the therapeutic pressure levelrequired to treat the eye condition of the eye 100.

Transmitting an indication of the therapeutic pressure level can includecommunicating the control signal through an output channel of thecontrol circuit 230, such as a first output of the control circuit 230,to a device, such as a device operable to deliver the therapeuticpressure level to the goggle enclosure 210. In an example, the firstoutput of the control circuit 230 can be electrically connected to thepump 220, such that the pump 220 can receive the pump control signal toset, or otherwise generate and control, the gauge pressure delivered tothe goggle enclosure 210. In an example, the first output of the controlcircuit 230 can be electrically connected to one or more valveassemblies, such as motorized valve assemblies including controllablevents and motorized venturi valve assemblies, the valve assembliesincluding one or more pressurized fluid sources, such as a fluid sourcecontaining a positive or negative gauge pressure connected to the goggleenclosure 210 through the valve assemblies.

Setting a therapeutic pressure in the goggle enclosure 210 can includeapplying a therapeutic pressure to the goggle enclosure 210 to treat aneye condition, such as an abnormal eye condition. Therapeutic pressurecan be generated with a pressure source, such as the pump 220, andapplied to the cavity 212 of the goggle enclosure 210, such as bycreating a gauge pressure in the goggle enclosure 210, to treat an eyecondition of the eye 100. The applied therapeutic pressure can include agauge pressure, such as a positive or negative gauge pressure applied tothe goggle enclosure 210. The gauge pressure can be generated on demand,such as with the pump 220, or supplied by one or more pressurized fluidsources, such as a pressurized cylinder of gas, including a controlvalve, such as a pressure regulator, to meter gauge pressure applied tothe goggle enclosure 210.

Setting a therapeutic pressure in the goggle enclosure 210 can includeestablishing the duration of therapeutic pressure to apply to the cavity212 to treat the eye condition of the eye 100. The duration oftherapeutic pressure applied can depend on the eye condition treatedwith the therapeutic pressure. In an example, establishing the durationof therapeutic pressure applied can include identifying the eyecondition of the eye 100 requiring treatment and prescribing theduration of therapeutic pressure to apply to the cavity 212. Prescribinga duration of therapeutic pressure can include specifying a length oftime to apply the therapeutic pressure to the cavity 212.

Further monitoring of the received data to control the pump can includeadjusting the therapeutic pressure, such as in the goggle enclosure 210.Adjusting the therapeutic pressure can include improving the effect ofthe applied therapeutic pressure can include varying the therapeuticpressure level applied to the goggle enclosure 210 to minimize thedifference between the received indications of one or more feedbacksignals and a received target value of the physiological parameter.Adjusting the therapeutic pressure for application to the eye 100 caninclude the use of feedback control principles, such as closed-loopcontrol principles implemented with algorithms running on the CPU of thecontrol circuit 224, to adjust the therapeutic pressure level applied tothe goggle enclosure 210.

Adjusting the therapeutic pressure in the goggle enclosure 210 caninclude detecting one or more feedback signals, such as from a patientwearing the apparatus 200. The one or more feedback signals can includeinformation regarding a pressure indication including an indication of aphysiological parameter and an indication of the therapeutic pressurelevel applied to the goggle enclosure 210, such as detected with one ormore sensing instruments 513. The apparatus 200 can receive informationregarding the one or more feedback signals with the control circuit 224,such as by receiving one or more feedback signals with one or more inputchannels on the control circuit 224.

Adjusting the therapeutic pressure level in the goggle enclosure 210 caninclude processing one or more feedback signals. Processing a feedbacksignal can include calculating a composite indication of a physiologicalparameter, such as where the composite indication can be a function ofone or more feedback signals.

Adjusting the therapeutic pressure level in the goggle enclosure 210 caninclude receiving updated target values for the feedback signals, suchas updated target values for one or more indications of a physiologicalparameter and one or more indications of the body parameters of thepatient. Updated target values can be received from a user of theapparatus 200, such as through the UI of the control circuit 224.Receiving updated target values can further include calculating updatedcomposite target values for the feedback signals, such as with the CPUof the control circuit 224, based upon received updated target values.

Adjusting the therapeutic pressure level in the goggle enclosure 210 caninclude determining the difference between the feedback signals and thereceived target values for the feedback signals, such as to form anupdated error signal.

Adjusting the therapeutic pressure level can include selecting anupdated therapeutic pressure level based on the updated error signal,and transmitting an updated control signal, such as an updated pumpcontrol signal, to a device operable to deliver the updated therapeuticpressure to the goggle enclosure 210, such as the pump 220.

Adjusting the fluid pressure, such as the fluid pressure level 503, caninclude generating a pump signal 501, such as in response to a detectedeye parameter signal 502. A detected eye parameter signal can bedetected, such as by performing a visualization, such as of the centralretinal vein 133 displaying a SVP, and analyzing the visualization, suchas analyzing first and subsequent visualizations, such as of the SVP, todetermine a change in at least one eye or other physiologiccharacteristic between the first and subsequent visualizations, such asa change in caliber of the SVP. Visualization can be performed with aVAD 509, such as an OCT system 509D. Based on the detected eye parametersignal 502, such as the change in caliber of the SVP, the controlcircuit can generate a pump signal 501, such as an adjusted pump signalthat can be at least one of in-phase or out-of-phase with the detectedeye parameter signal 502. In an example, the pump signal 501, such as anin-phase pump signal 501, can generate a fluid pressure level 503, suchas an in-phase fluid pressure level 503 that can be applied to thegoggle enclosure 210, such as to minimize the dynamic component of TMP.In an example, the pump signal 501, such as an out-of-phase pump signal501, can generate a fluid pressure level 503, such as an out-of-phasefluid pressure level 503 that can be applied to the goggle enclosure210, such as to maximize the dynamic component of TMP.

Controlling the pump 220 can include processing the received data, suchas with the control circuit 230. The received data can include thecomposite signal 513, such as can include at least one of the detectedeye parameter signal 510, the target eye parameter signal 512, or theenclosure sensor signal 507.

Controlling the pump 220 can include transmitting an indication of theprocessed composite data 501 to the pump 220. Indications of theprocessed composite data 501 can be transmitted by at least one of anelectrical connection, such with a wired connection between the controlcircuit 230 and the pump 220, or a wireless connection. The pump 220 canreceive the indication of the processed data 201, such as by at leastone of an electrical interface, such as with a wired interface betweenthe control circuit 230 and the pump 220, or a wireless interface, FIG.10 shows an example of a method 1000 for using the apparatus 200 toapply a pressure to an eye 100 to monitor ICP. At 1006, an imagingdevice or other visualization assistance device 509 can visualize aportion of the eye 100, such as at different fluid pressures within thegoggle enclosure 210, such as to monitor an indication of ICP.

FIG. 11 shows an example of a method 1100 for using the apparatus 200 toapply a pressure to an eye 100, such as for determining ICP ormonitoring ICP. At 1208, a first visualization of a patient eye 100 at afirst fluid pressure can be performed, such as with a goggle enclosure210 sized and shaped to be located over the patient eye 100 withoutcontacting the patient eye 100.

At 1110, a subsequent visualization of the patient eye 100 at asubsequent fluid pressure can be performed, such as the subsequent fluidpressure can be different from the first fluid pressure. A subsequentvisualization can include a visualization, such as a visualizationperformed after the first visualization, such as a second, third,fourth, fifth, or other visualization.

At 1112, the first and subsequent visualizations can be used todetermine a change, such as in at least one eye characteristic, such ascorresponding to the change between the first and second fluid pressureswithin the enclosure. The eye characteristic can include a change in thecaliber of a blood vessel, such as a blood vessel of the eye, such as atleast one of a blood vessel in the intraocular space including a venousblood vessel, or a blood vessel on the patient eye 100, such as anepiscleral venous vessel. The eye characteristic can include a state ofa blood vessel, such as a collapsed state of an intraocular venous bloodvessel, such as due to a fluid pressure applied to the cavity 212 of thegoggle enclosure 210. In an example, an eye characteristic changecriterion can include the collapse of an intraocular venous bloodvessel, such as due to a fluid pressure applied to the cavity 212 of thegoggle enclosure 210.

Performing a visualization can include selecting a VAD 509, such as aVAD 509 to achieve the objectives of examination for the patient eye100. Performing a visualization can include selecting one or moredetector devices 508, such as to be used in combination with a VAD 509,to achieve at least one of determining or monitoring an eyecharacteristic.

Determining a change in at least one eye characteristic can includeprocessing a visualization, such as with a processing technique. Aprocessing technique can include manually processing at least onevisualization, such as by observing a visualization, such as with theeye of an observer.

Observing a visualization can include perceiving an undocumented imageof a patient eye 100, such as an observer observing a patient eye 100,and assessing the eye 100, such as by drawing a conclusion based uponobservation of the undocumented image. In an example, processing avisualization can include an observer, such as an ophthalmologist,observing a patient eye 100, such as with an ophthalmoscope, tovisualize an eye characteristic, such as the cup-to-disc ratio of theoptic nerve 118, to determine an indication of the presence of apossible abnormality in the patient eye 100, such as a cup-to-disc ratiothat can be different from a ratio of 0.3.

Observing a visualization can include perceiving one or moreundocumented images of a patient eye 100, such as to detect a change inan eye characteristic between at least one of a first or subsequentundocumented images. In an example, processing a visualization caninclude locating an apparatus 200 on a patient eye 100, applying a firstfluid pressure to a cavity 212 of the goggle enclosure 210, visualizingan eye characteristic of the patient eye 100, such as a cup-to-discratio due to the first fluid pressure, applying a second fluid pressureto the cavity 212, such as a second fluid pressure different from thefirst fluid pressure, visualizing the eye characteristic, such as thecup-to-disc ratio due to the second fluid pressure, and detecting achange in the cup-to-disc ratio due to the first and second fluidpressures, such as by detecting a change between the first and secondimages, such as first and second undocumented images.

A processing technique can include digitally processing at least onevisualization, such as by observing a visualization with a VAD 509, suchas a VAD 509 with the capability to store a digital image.

Observing a visualization can include perceiving a documented image of apatient eye 100, such as with a VAD 509 with the capability to store adigital image, and assessing the eye 100, such as by drawing aconclusion based upon observation of the documented image. In anexample, processing a visualization can include an observer, such as anophthalmologist observing the documented image of a patient eye 100,such as the cup-to-disc ratio of the optic nerve 118, to determine anindication of the presence of a possible abnormality in the patient eye100, such as a cup-to-disc ratio that can be different from a ratio of0.3.

Observing a visualization can include perceiving one or more documentedimages of a patient eye 100, such as to detect a change in an eyecharacteristic between at least one of a first or subsequent documentedimages. In an example, processing a visualization can include locatingan apparatus 200 on a patient eye 100, applying a first fluid pressureto a cavity 212 of the goggle enclosure 210, visualizing an eyecharacteristic of the patient eye 100, such as a cup-to-disc ratio dueto the first fluid pressure with a first image, applying a second fluidpressure to the cavity 212, such as a second fluid pressure differentfrom the first fluid pressure, visualizing the eye characteristic, suchas the cup-to-disc ratio due to the second fluid pressure with a secondimage, and detecting a change in the cup-to-disc ratio due to the firstand second fluid pressures, such as by observing a change between thefirst and second images, such as first and second digital images.

Analyzing can include observing a change, such as between first andsecond digital images. Observing a change can include manuallyprocessing the first and second digital images, such as to determine achange in an indication of an eye characteristic. Manually processingcan include detecting a change between a first and second digital image,such as a change between at least one of pixel or voxel characteristicsin corresponding digital elements with an eye of an observer. Detectinga change can include the eye of an observer perceiving the first digitalimage, perceiving the second digital image, and determining differencesbetween the first and second digital images.

Observing a change between first and second digital images can includedigitally processing the first and second digital images, such as todetermine a change in an indication of an eye characteristic. Digitallyprocessing a first and second image can include detecting a changebetween a first and second digital image, such as a change between atleast one of pixel or voxel characteristics in corresponding digitalelements with a computing device. Detecting a change can include placingrepresentations of the first and second digital images into the memoryof a computing device, such as random access memory or RAM, and runningan algorithm, such as a digital comparator algorithm, to determinedifferences between the first and second digital images. Running analgorithm can include initiating a software code, such as a softwarecode implemented on a computing device, and applying a set ofinstructions in the software code to the representations of the firstand second digital images.

FIG. 12 shows an example of a method 1200 for using the apparatus 200,such as for determining an indication of ICP. At 1202, a firstvisualization of a patient eye 100 at a first fluid pressure within oneor more cavities 212 of an goggle enclosure 210 sized and shaped to belocated over the patient eye 100 without contacting the patient eye 10can be performed, the visualization carried out with the goggleenclosure 210 located over the patient eye 100.

At 1204, a subsequent visualization of a patient eye 100 at a subsequentfluid pressure within one or more cavities 212 of a goggle enclosure210, the visualization carried out with the goggle enclosure 210 locatedover the patient eye 100, the subsequent fluid pressure different fromthe first fluid pressure.

At 1206, the first and subsequent visualizations can be used todetermine a change in at least one eye or other physiologicalcharacteristic corresponding to the change between the first andsubsequent fluid pressures within the enclosure.

FIG. 13 shows an example of a method 1300 for using the apparatus 200for synchronizing pressure applied to the goggle enclosure 210 with thepatient cardiac cycle. At 1308, a fluid pressure within the one or morecavities of the goggle enclosure 210 can be adjusted in correspondencewith one or more portions of a cardiac cycle of the patient.

FIG. 14 shows an example of a method 1400 for using the apparatus 200for determining ICP based upon an indication of the patient cardiaccycle. At 1410, the first and subsequent visualizations can be analyzedto determine an indication of an intrabody pressure based upon a changein at least one eye or other physiological characteristic between thefirst and subsequent visualizations.

FIG. 15 shows an example of a method 1500, such as for conducting adiagnostic examination of the eye 100 after concluding a therapeuticsession using the apparatus 200. The method 1500 can include an exampleof a method for using the apparatus 200, such as by combining adiagnostic method and a therapeutic method, such as for monitoring andtreating at least one of an acute or a chronic abnormal eye condition.

At 1502, a gauge pressure can be released from a goggle enclosure 210sized and shaped to be located over a patient eye 100 without contactingthe eye.

At 1504, a visualization of the patient eye 100 can be performed at anatmospheric fluid pressure within the goggle enclosure 210, thevisualization carried out with the goggle enclosure 210 located over thepatient eye 100, to detect an eye characteristic meeting an eyecharacteristic rebound criterion. In an example, an eye characteristicrebound criterion can include the recovery of the central retinal vein133 to an ambient cross-sectional shape, such as a generally circularshape. At 1506, a gauge pressure can be applied to the goggle enclosure210, such as to achieve an eye characteristic change criterion. In anexample, an eye characteristic change criterion can include the collapseof an intraocular venous blood vessel, such as due to a fluid pressureapplied to the cavity 212 of the goggle enclosure 210.

Applying a gauge pressure to the patient eye 100, such as a positive ornegative gauge pressure, can cause the patient eye 100 to deform, suchas at least one of compressing due to a positive gauge pressure orexpanding due to a negative gauge pressure, to assume a deformed state.Short term deformation of the patient eye 100, such as deformationinduced during a diagnostic examination using the apparatus 200, cancause a change in the eye characteristics of the patient eye 100, suchas a temporary change in the eye characteristics of the patient eye 100as referenced from baseline eye characteristics. Baseline eyecharacteristics, such as a first set of baseline eye characteristics,can include eye characteristics detected from a patient eye 100 in arelaxed state, such as in the absence of a gauge pressure applied to thepatient eye 100 including eye characteristics detected at an ambient oratmospheric pressure.

Long term deformation of the patient eye 100, such as deformationinduced during therapeutic use of the apparatus 200 on the patient eye100, can cause the patient eye 100 to remodel or otherwise adapt to theapplied fluid pressure, such as to induce a permanent change in the eyecharacteristics, such as to permanently shift the first set of baselineeye characteristics of the patient eye 100. In other words, remodelingof a patient eye 100, such as due to long term deformation of thepatient eye 100 with the use of the apparatus 200, can cause the patienteye 100 to assume a second set of baseline eye characteristics, thesecond set of baseline eye characteristics different from the first setof baseline eye characteristics.

Assessment of the patient eye 100, such as an assessment to determinethe effectiveness of a therapeutic regimen, can benefit from conductingdiagnostic tests on a patient eye 100 in a relaxed state. The time for apatient eye 100 to transition from a deformed state to relaxed state canvary, such as due to patient physiology.

Releasing the gauge pressure, such as from the goggle enclosure 210, caninclude exposing the patient eye 100 to an ambient pressure, such as toallow the patient eye 100 to recover from a deformed state to a relaxedstate. An ambient pressure can include at least one of an atmosphericpressure or a fluid pressure not influenced by the pump 220. Gaugepressure can be released through the controllable vent, such as byopening the controllable vent, such as by providing a low resistancefluid path to equalize the differential fluid pressure between thegoggle enclosure 210 and the surrounding atmosphere. Gauge pressure canbe released by turning off the pump 220, such as allow gauge pressure inthe goggle enclosure 210 to bleed off, such as by providing a variableresistance fluid path to equalize the differential fluid pressurebetween the goggle enclosure 210 and the surrounding atmosphere.

Detecting an eye characteristic meeting an eye characteristic reboundcriterion can include visualizing a portion of the patient eye 100, suchas a portion of the patient eye 100 including an indication of an eyecharacteristic, observing the visualization, such as to compare the eyecharacteristic to an eye characteristic rebound criterion. In anexample, an eye characteristic, such as the caliber of a central retinalvein 133 deformed due to a gauge pressure in an goggle enclosure 210 ofan apparatus 200, can be visualized, such as with an OCT system 509D,such as during release of gauge pressure from the goggle enclosure 210,and compared to an eye characteristic rebound criterion, such as therelaxed caliber of the central retinal vein 133.

Releasing the gauge pressure can include visualizing the eye 100, suchas after an eye characteristic rebound criterion of the eye 100 has beenachieved. In an example, the patient eye 100 can be visualized, such asto detect an indication of an eye characteristic, such as with thepatient eye 100 in a relaxed state. The relaxed caliber of a centralretinal vein 133 can be determined, such as by at least one of measuringthe caliber of the central retinal vein 133 in a relaxed state, such asin the patient eye 100 under atmospheric conditions, or by calculatingan estimate of the caliber of the central retinal vein 133. Calculatingan estimate of the caliber of the central retinal vein 133 can includeperforming a visualization of the central retinal vein 133 subjected toa gauge pressure applied with the apparatus 200, such as at a gaugepressure sufficient to cause the central retinal vein 133 to collapse,detecting the caliber of the central retinal vein 133, such as in adeformed state, such as at collapse of the central retinal vein 133, andcalculating an estimate of the caliber of the relaxed central retinalvein 133. Calculating an estimate of the caliber of the relaxed centralretinal vein 133 can include dividing the detected caliber of thecentral retinal vein 133, such as in a collapsed state, by themathematical constant known as pi (π), such as to calculate an estimateof the radius of the undeformed central retinal vein 133, andmultiplying the estimate of the radius by 2 resulting in an estimate ofthe caliber of the undeformed central retinal vein 133.

Setting a therapeutic pressure can include identifying an eye conditionof the eye 100, such as an abnormal eye condition, such as for purposesof prescribing a treatment regimen of therapeutic pressure for the eyecondition. The presence of an abnormal eye condition can be identifiedthrough evaluation of one or more indications of an eye characteristic,such as the TPD of the eye 100. An indication of TPD can include thecup-to-disc ratio of the optic disc 150. An eye 100 with a cup-to-discratio of about 0.3 can indicate a “normal” TPD for the eye 100, such asan eye 100 with physiologically normal function. An eye 100 with acup-to-disc ratio less than or greater than about 0.3 can indicate an“abnormal” TPD, such as an eye 100 without physiologically normalfunction, such as an eye 100 requiring treatment.

A value of the cup-to-disc ratio greater than about 0.3 can indicate thepresence of an abnormal eye condition, such as glaucoma. For example,cup-to-disc ratios in the range of about 0.35 to about 0.9, such ascup-to-disc ratios of about 0.35, about 0.4, about 0.5, about 0.6, about0.7, about 0.8, and about 0.9, can indicate the presence of an abnormaleye condition including glaucoma. A value of the cup-to-disc ratio lessthan about 0.3 can indicate the presence of an abnormal eye condition,such as optic disc edema. For example, a cup-to-disc ratio of about0.25, about 0.2, about 0.15, about 0.1, about 0.05, and the absence of adiscernible cup in the optic disc 150, such as indicated with acup-to-disc ratio of about 0.00, can indicate the presence of anabnormal eye condition including optic disc edema and papilledema.

FIG. 16 shows an example of a method 1600 for determining at least oneof ICP or IOP using the apparatus 200, such as for diagnostic purposes.At 1602, the apparatus 200 can be located on a patient, such as apatient suspected of suffering from an abnormal eye condition.

At 1604, a visualization assistance device 509 can be selected, such asto visualize at least a portion of the patient eye 100. Selection of theVAD 509 can be based on whether IOP, ICP or both are to be measured.

At 1606, a visualization can be performed on the patient eye 100, suchas a first visualization at a first fluid pressure. The apparatus 200can record metadata, including applied pressure, etc. The first imagecan include a baseline image, such as an image to which other images canbe compared to detect a change in an eye characteristic.

At 1608, a visualization, such as a second visualization at a secondfluid pressure, can be performed. The second fluid pressure can bedifferent from the first fluid pressure.

At 1610, first and second visualizations can be used to determine achange in at least one eye or other physiological characteristiccorresponding to the change between the first and second fluid pressureswithin the enclosure.

At 1612, the change in an eye characteristic can be compared to at leastone change criterion, such as to determine if the change criterion hasbeen achieved.

At 1614, the second visualization can be renamed as the firstvisualization, and a subsequent visualization acquired, such as untilthe eye characteristic change criterion can be achieved.

FIG. 17 shows an example of a method 1700 for using the apparatus 200,such as for therapeutic purposes including treating at least one of anacute or a chronic abnormal eye condition.

At 1702, the apparatus 200 can be located on a patient, such as apatient diagnosed with an abnormal eye condition.

At 1704, a detected eye parameter signal 510 can be received at the datainterface 232.

At 1706, the detected eye parameter signal 510 can be processed by thecontrol circuit 230, such as to form a pump control signal 501.Processing can include comparing an indication of the first fluidpressure to a setpoint, such as to calculate an error signal. The pumpcontrol signal 501 can include a pump signal, such as a pump signal thatreduces the error signal at a predetermined rate. At 1708, the pumpcontrol signal 501 can be received by the pump 220, such as to adjustthe fluid pressure delivered to the goggle enclosure 210 from a firstpressure to a second pressure, the second pressure different from thefirst pressure.

At 1710, the fluid pressure in the goggle enclosure 210 can bemonitored, such as to drive and error signal to zero.

At 1712, the error signal can be maintained at zero, such as for aclinically relevant period of time.

FIG. 18 illustrates an example method 1800 of setting and adjusting atherapeutic pressure using TOP for application to an eye 100, such asfor treatment of an abnormal eye condition. At 1802, an apparatus 200can be worn by a patient, such as locating a goggle enclosure 210 overan eye 100 of a patient, so that the goggle enclosure 210 contacts theskin of the patient, such as to form a hermetic seal between the goggleenclosure 210 and the skin of the patient.

At 1804, information regarding a pressure indication, such as anindication of a physiological parameter including TOP, can be detected,such as with a sensing instrument 513 including an internal sensinginstrument 513 b.

At 1806, the indication of TOP, can be received by the control circuit224, such as at a first input channel of the control circuit 224.

At 1808, the difference between the received indication of TOP and anTOP target value, such as an TOP target value received through the UIattached to the control circuit 224, can be determined, such as by a CPUattached to the control circuit 224. The difference between the receivedindication of TOP and an TOP target value can be a signal, such as anerror signal.

At 1810, the pump command signal can be selected, such as based on theerror signal, and transmitted from the CPU through one or more outputchannels of the control circuit 224 to another device, such as a pump220, to control operation of the device.

At 1812, the pump 220 can respond to receiving the pump command signalfrom one or more output channels of the control circuit 224, such as byoperating the pump to generate a therapeutic pressure to apply to thegoggle enclosure 210 of the apparatus 200.

At 1814, the therapeutic pressure can be applied to the goggle enclosure210 to create a therapeutic pressure level in the cavity 212, such as totreat an eye condition.

At 1816, a sensing instrument 513, such as an internal sensinginstrument 513 b, can detect a change in an indication of aphysiological parameter, such as TOP, in response to applying thetherapeutic pressure. The change in TOP can be a feedback signal, suchas an TOP feedback signal.

At 1818, the TOP feedback signal, can be received by the control circuit224, such as at a first input channel of the control circuit 224.

At 1820, the difference between the TOP feedback signal and an TOPtarget value, such as an updated TOP target value, can be determined,such as with the CPU attached to the control circuit 224. The differencebetween the TOP feedback signal and an updated TOP target value can be asignal, such as an updated error signal.

At 1822, the updated pump command signal can be selected, such as basedon the updated error signal, and transmitted from the CPU through one ormore output channels of the control circuit 224 to another device, suchas the pump 220, to modify operation of the device.

At 1824, the pump 220 can respond to receiving the updated pump commandsignal, such as by operating the pump to generate an updated therapeuticpressure to apply to the goggle enclosure 210 of the apparatus 200.

VARIOUS NOTES

To further illustrate the apparatus and methods of the presentdisclosure, a non-limiting list of Examples is provided here:

Example 1 can include or use subject matter, such as an apparatus for atleast one of diagnosing or treating an eye condition. The subject mattercan comprise a goggle enclosure, sized and shaped to be seated on an eyesocket of an eye to provide one or more cavities within the enclosurethat extend about an entire exposed anterior portion of the eye, a pump,in fluidic communication with the one or more cavities to apply a fluidpressure to the one or more cavities, the pump configured to adjust afluid pressure within the one or more cavities of the goggle enclosure,and a control circuit, including a data interface to receive datadirectly or indirectly indicating at least one of intraorbital pressure,ICP, IOP, or a relationship between ICP and IOP, and based on processingthe received data as a feedback control variable, controlling the pumpto adjust the fluid pressure within the one or more cavities, thecontrolling including using further monitoring of the received data tocontrol the pump.

Example 2 can include, or can optionally be combined with the subjectmatter of Example 1, to optionally include a data interface attached tothe control circuit to receive data directly indicating at least one ofintraorbital pressure, ICP, IOP, or a relationship between ICP and IOP,the received data including an indication of at least one of, a sensedIOP sensed by a pressure sensor previously placed within an intraocularspace of the eye, a sensed ICP sensed by a sensor previously placed influid communication with a cerebrospinal region, or a sensedintraorbital pressure sensed by a sensor previously placed in fluidcommunication with the orbit of the skull.

Example 3 can include, or can optionally be combined with the subjectmatter of Example 1 or 2 to optionally include the control circuit datainterface to receive data indirectly indicating at least one ofintraorbital pressure, ICP, IOP, or a relationship between ICP and IOP,the received data including an indication of at least one of an eyeblood vessel characteristic, a translaminar pressure differenceincluding a cup-to-disc relationship, a systemic blood pressure, a bodyparameter including a body mass index (BMI), a differential hydrostaticpressure corresponding to different postural positions or orientations,a spontaneous venous pulsation or an induced venous pulsation, a laminarcribrosa shape or position, an episcleral venous pressure, or an orbitalpressure.

Example 4 can include, or can optionally be combined with the subjectmatter of Examples 1-3 to optionally include a visualization assistancedevice to visualize a portion of the eye at different fluid pressureswithin the enclosure to monitor an indication of ICP.

Example 5 can include, or can optionally be combined with the subjectmatter of Examples 1-4 to optionally include a visualization assistancedevice wherein the visualization assistance device is configured toobtain an indication of cup-to-disc ratio.

Example 6 can include, or can optionally be combined with the subjectmatter of Examples 1-5 to optionally include a visualization assistancedevice to provide at least some of the data, wherein the visualizationassistance device includes a fundus camera.

Example 7 can include, or can optionally be combined with the subjectmatter of Examples 1-6 to optionally include a visualization assistancedevice to provide at least some of the data, wherein the imaging deviceincludes an optical coherence tomography (OCT) system.

Example 8 can include, or can optionally be combined with the subjectmatter of Examples 1-7 to optionally include a blood pressure sensor toprovide at least some of the data.

Example 9 can include, or can optionally be combined with the subjectmatter of Examples 1-8 to optionally include a detector device toprovide at least some of the data by detecting a change in at least oneof a blood vessel dimension, flow characteristic, pulsation,oxygenation, or color characteristic.

Example 10 can include, or can optionally be combined with the subjectmatter of Examples 1-9 to optionally include a differential hydrostaticpressure sensor including an inclinometer or posture sensor to provideat least some of the data.

Example 11 can include, or can optionally be combined with the subjectmatter of Examples 1-10 to optionally include a tonometer to provide atleast some of the data, the tonometer being integrated with or coupledto the enclosure to provide access of the tonometer to the eye.

Example 12 can include, or can optionally be combined with the subjectmatter of Examples 1-11 to optionally include a contact lens to provideat least some of the data, wherein the contact lens includes anintegrated strain or other sensor to detect an eye characteristic.

Example 13 can include, or can optionally be combined with the subjectmatter of Examples 1-12 to optionally include an axonal transportimaging device to provide at least some of the data.

Example 14 can include, or can optionally be combined with the subjectmatter of Examples 1-13 to optionally include a laminar cribrosaposition or shape detection device to provide at least some of the data.

Example 15 can include, or can optionally be combined with the subjectmatter of Examples 1-14 to optionally include wherein the data interfaceis to receive and process an indication of ICP obtained by performing afirst visualization of a patient eye at a first fluid pressure within angoggle enclosure sized and shaped to be located over the patient eyewithout contacting the patient eye, the visualization carried out withthe goggle enclosure located over the patient eye, performing one ormore subsequent visualizations of the patient eye at one or moresubsequent fluid pressures within the goggle enclosure, thevisualization carried out with the goggle enclosure located over thepatient eye, the subsequent fluid pressures different from the firstfluid pressure, and using the first and subsequent visualizations,determining a change in at least one eye characteristic corresponding tothe change between the first and subsequent fluid pressures within theenclosure.

Example 16 can include or use subject matter, such as an apparatus forat least one of diagnosing or treating an eye condition. The subjectmatter can comprise a goggle enclosure, sized and shaped to be seated onan eye socket of an eye to provide one or more cavities within theenclosure that extend about an entire exposed anterior portion of theeye, a pump, in fluidic communication with the one or more cavities toapply a fluid pressure to the one or more cavities, the pump configuredto adjust a fluid pressure within the one or more cavities of the goggleenclosure, and a visualization assistance device, in communication withthe pump, for visualizing at least a portion of the patient eye when thegoggle enclosure is seated against the patient for the pump to adjustthe fluid pressure within the cavity of the goggle enclosure.

Example 17 can include, or can optionally be combined with the subjectmatter of Example 16, to optionally include a control circuit,controlling the pump to adjust the fluid pressure within the one or morecavities for visualizing using the visualization assistance device atone or more fluid pressures within the one or more cavities of thegoggle enclosure.

Example 18 can include, or can optionally be combined with the subjectmatter of Example 16 or 17 to optionally include wherein the controlcircuit is configured to control the pump to adjust the fluid pressurewithin the one or more cavities for visualizing using the visualizationassistance device at one or more fluid pressures within the one or morecavities of the goggle enclosure, including for performing a firstvisualization of a patient eye at a first fluid pressure within the oneor more cavities of the goggle enclosure, performing one or moresubsequent visualizations of the patient eye at one or more subsequentfluid pressures within the goggle enclosure, the visualization carriedout with the goggle enclosure located over the patient eye, thesubsequent fluid pressures different from the first fluid pressure, andusing the first and subsequent visualizations, determining a change inat least one eye characteristic corresponding to the change between thefirst and subsequent fluid pressures within the enclosure.

Example 19 can include, or can optionally be combined with the subjectmatter of Examples 16-18 to optionally include wherein the visualizationassistance device includes an optical coherence tomography (OCT) device.

Example 20 can include, or can optionally be combined with the subjectmatter of Examples 16-19 to optionally include wherein the visualizationassistance device includes a fundus camera.

Example 21 can include, or can optionally be combined with the subjectmatter of Examples 16-20 to optionally include wherein the visualizationassistance device includes an ultrasound imaging device.

Example 22 can include, or can optionally be combined with the subjectmatter of Examples 16-21 to optionally include wherein the visualizationassistance device includes or is coupled to an image processor circuitto analyze the first and subsequent visualizations to determine a changein at least one eye or other physiologic characteristic between thefirst and subsequent visualizations.

Example 23 can include, or can optionally be combined with the subjectmatter of Examples 16-22 to optionally include wherein the imageprocessor circuit is configured to compare pixels or voxels associatedwith an image of a blood vessel to determine a change in blood flowvelocity between the first and subsequent visualizations at differentapplied pressures within the one or more cavities of the enclosure.

Example 24 can include, or can optionally be combined with the subjectmatter of Examples 16-23 to optionally include wherein the imageprocessor circuit is configured to compare pixels or voxels associatedwith an image of a blood vessel to determine a change in a colorcharacteristic associated with a blood vessel between the first andsubsequent visualizations at different applied pressures within the oneor more cavities of the enclosure.

Example 25 can include, or can optionally be combined with the subjectmatter of Examples 16-24 to optionally include wherein the imageprocessor circuit is configured to determine whether a change in an eyeor other physiological characteristic between the first and subsequentvisualizations indicates whether a specified blood vessel caliber changeor other specified criterion has been met.

Example 26 can include, or can optionally be combined with the subjectmatter of Examples 16-25 to optionally include wherein the imageprocessor circuit is configured to determine an indication of anintrabody pressure based upon a change in an eye or other physiologicalcharacteristic between the first and subsequent visualizations atdifferent applied pressures within the one or more cavities of theenclosure.

Example 27 can include, or can optionally be combined with the subjectmatter of Examples 16-26 to optionally include wherein the imageprocessor circuit is configured to correlate a cerebrospinal fluid (CSF)pressure to the indication of intrabody pressure based upon a change inan eye or other physiological characteristic between the first andsubsequent visualizations at different applied pressures within the oneor more cavities of the enclosure.

Example 28 can include, or can optionally be combined with the subjectmatter of Examples 16-27 to optionally include wherein the visualizationassistance device includes or is coupled to an image processor circuitto analyze the first and subsequent visualizations to determine a changein at least one eye or other physiologic characteristic between thefirst and subsequent visualizations, wherein the at least one eye orother physiologic characteristic includes at least one amplitude, bloodvessel caliber, location, or other characteristic of a spontaneousvenous pulsation or induced venous pulsation.

Example 29 can include, or can optionally be combined with the subjectmatter of Examples 16-28 to optionally include wherein the controlcircuit is configured to operate the pump to adjust a fluid pressurewithin the one or more cavities of the goggle enclosure incorrespondence with one or more portions of an ocular pulse cycle of thepatient.

Example 30 can include, or can optionally be combined with the subjectmatter of Examples 16-29 to optionally include wherein the controlcircuit is configured to operate the pump to adjust a fluid pressurewithin the one or more cavities of the goggle enclosure incorrespondence with one or more portions of an ocular pulse cycle of thepatient.

Example 31 can include, or can optionally be combined with the subjectmatter of Examples 16-30 to optionally include wherein the controlcircuit is configured to operate the pump to adjust a fluid pressurewithin the one or more cavities of the goggle enclosure incorrespondence with one or more portions of a cardiac cycle of thepatient over a plurality of cardiac cycles of the patient so as tochange (maximize, minimize, or neutralize) an amplitude or othercharacteristic of a spontaneous blood vessel pulsation, induced venouspulsation, or other eye or other physiologic characteristic over theplurality of cardiac cycles.

Example 32 can include, or can optionally be combined with the subjectmatter of Examples 16-31 to optionally include wherein the controlcircuit is configured to operate the pump to adjust a fluid pressurewithin the one or more cavities of the goggle enclosure incorrespondence with one or more portions of an ocular pulse cycle of thepatient over a plurality of ocular cycles of the patient so as to changean amplitude or other characteristic of a spontaneous blood vesselpulsation, induced venous pulsation, or other eye or other physiologiccharacteristic over the plurality of ocular pulse cycles.

Example 33 can include, or can optionally be combined with the subjectmatter of Examples 16-32 to optionally include wherein the controlcircuit is configured to operate the pump to adjust a fluid pressurewithin the one or more cavities of the goggle enclosure incorrespondence with one or more portions of an intracranial pressurecycle of the patient over a plurality of intracranial pressure cycles ofthe patient so as to change an amplitude or other characteristic of aspontaneous blood vessel pulsation, induced venous pulsation, or othereye or other physiologic characteristic over the plurality ofintracranial pressure cycles.

Example 34 can include, or can optionally be combined with the subjectmatter of Examples 16-33 to optionally include wherein the visualizationassistance device includes or is coupled to an image processor circuitto analyze the first and one or more subsequent visualizations todetermine an indication of an intrabody pressure based upon a change inat least one eye or other physiologic characteristic between the firstand subsequent visualizations.

Example 35 can include or use subject matter, such as a method. Thesubject matter can comprise a method comprising, receiving data directlyor indirectly indicating at least one of intracranial pressure (ICP),intraocular pressure (TOP), or a relationship between ICP and IOP, andbased on the received data as a feedback control variable, controlling apump to adjust a fluid pressure within an goggle enclosure sized andshaped to be located over the patient eye without contacting the patienteye, the controlling including using further monitoring of the receiveddata to control the pump.

Example 36 can include, or can optionally be combined with the subjectmatter of Example 1, to optionally include wherein the receiving dataincludes receiving data directly indicating at least one of intraorbitalpressure, ICP, IOP, or a relationship between ICP and IOP using anindication of at least one of a sensed IOP sensed by a fluid pressuresensor previously placed within an intraocular space of the eye, asensed ICP sensed by a fluid pressure sensor previously placed in fluidcommunication with a cerebrospinal region, or a sensed intraorbitalpressure sensed by a sensor previously placed in fluid communicationwith a cerebrospinal region.

Example 37 can include, or can optionally be combined with the subjectmatter of Example 35 or 36 to optionally include wherein the receivingdata includes receiving data indirectly indicating at least one ofintraorbital pressure, ICP, IOP, or a relationship between ICP and IOP,the received data including an indication of at least one of, an eyeblood vessel characteristic, a translaminar pressure differenceincluding a cup-to-disc relationship, a systemic blood pressure, a bodyparameter including body mass index (BMI), a differential hydrostaticpressure corresponding to different postural positions or orientations,a spontaneous venous pulsation or induced venous pulsation, a laminarcribrosa shape or position, an episcleral venous pressure, or an orbitalpressure.

Example 38 can include, or can optionally be combined with the subjectmatter of Examples 35-37 to optionally include using a visualizationassistance device to visualize a portion of the eye at different fluidpressures within the enclosure to monitor an indication of ICP.

Example 39 can include, or can optionally be combined with the subjectmatter of Examples 35-38 to optionally include using a visualizationassistance device to obtain an indication of cup-to-disc ratio.

Example 40 can include, or can optionally be combined with the subjectmatter of Examples 35-39 to optionally include using a fundus camera asthe visualization assistance device.

Example 41 can include, or can optionally be combined with the subjectmatter of Examples 35-40 to optionally include using an opticalcoherence tomography (OCT) system as the visualization assistancedevice.

Example 42 can include, or can optionally be combined with the subjectmatter of Examples 35-41 to optionally include using an indication ofblood pressure data as at least some of the data.

Example 43 can include, or can optionally be combined with the subjectmatter of Examples 35-42 to optionally include using an indication of atleast one of spontaneous venous pulsation data or induced venouspulsation data as at least some of the data.

Example 44 can include, or can optionally be combined with the subjectmatter of Examples 35-43 to optionally include providing at least someof the data by detecting a change in at least one of a blood vesseldimension, flow characteristic, pulsation, oxygenation, or colorcharacteristic.

Example 45 can include, or can optionally be combined with the subjectmatter of Examples 35-44 to optionally include using information aboutthe inclination or posture of the patient to provide at least some ofthe data.

Example 46 can include, or can optionally be combined with the subjectmatter of Examples 35-45 to optionally include using a tonometer toprovide at least some of the data, the tonometer being integrated withor coupled to the enclosure to provide access of the tonometer to theeye.

Example 47 can include, or can optionally be combined with the subjectmatter of Examples 35-46 to optionally include using a contact lens toprovide at least some of the data, wherein the contact lens includes anintegrated strain or other sensor to detect an eye characteristic.

Example 48 can include, or can optionally be combined with the subjectmatter of Examples 35-47 to optionally include using information aboutaxonal transport to provide at least some of the data.

Example 49 can include, or can optionally be combined with the subjectmatter of Examples 35-48 to optionally include using information about alaminar cribrosa position or shape to provide at least some of the data.

Example 50 can include, or can optionally be combined with the subjectmatter of Examples 35-49 to optionally include performing a firstvisualization of a patient eye at a first fluid pressure within angoggle enclosure sized and shaped to be located over the patient eyewithout contacting the patient eye, the visualization carried out withthe goggle enclosure located over the patient eye, performing a one ormore subsequent visualizations of the patient eye at a subsequent fluidpressure within the goggle enclosure, the visualization carried out withthe goggle enclosure located over the patient eye, the subsequent fluidpressure different from the first fluid pressure, and using the firstand subsequent visualizations, determining a change in at least one eyecharacteristic corresponding to the change between the first andsubsequent fluid pressures within the enclosure.

Example 51 can include or use subject matter, such as a method. Thesubject matter can comprise performing a first visualization of apatient eye at a first fluid pressure within one or more cavities of angoggle enclosure sized and shaped to be located over the patient eyewithout contacting the patient eye, the visualization carried out withthe goggle enclosure located over the patient eye, performing asubsequent visualization of the patient eye at the subsequent fluidpressure within one or more cavities of the goggle enclosure, thevisualization carried out with the goggle enclosure located over thepatient eye, the subsequent fluid pressure different from the firstfluid pressure, and using the first and subsequent visualizations,determining a change in at least one eye or other physiologiccharacteristic corresponding to the change between the first andsubsequent fluid pressures within the enclosure.

Example 52 can include, or can optionally be combined with the subjectmatter of Example 51, to optionally include wherein the visualizationincludes performing optical coherence tomography (OCT).

Example 53 can include, or can optionally be combined with the subjectmatter of Example 51 or 52 to optionally include wherein thevisualization includes using a fundus camera.

Example 54 can include, or can optionally be combined with the subjectmatter of Examples 51-53 to optionally include wherein the visualizationincludes performing ultrasound imaging.

Example 55 can include, or can optionally be combined with the subjectmatter of Examples 51-54 to optionally include wherein the visualizationincludes analyzing the first and subsequent visualizations to determinea change in at least one eye or other physiologic characteristic betweenthe first and subsequent visualizations.

Example 56 can include, or can optionally be combined with the subjectmatter of Examples 51-55 to optionally include wherein analyzingincludes comparing pixels or voxels associated with an image of a bloodvessel to determine a change in blood flow velocity between the firstand subsequent visualizations at different applied pressures within theone or more cavities of the enclosure.

Example 57 can include, or can optionally be combined with the subjectmatter of Examples 51-56 to optionally include wherein analyzingincludes comparing pixels or voxels associated with an image of a bloodvessel to determine a change in a color characteristic associated with ablood vessel between the first and subsequent visualizations atdifferent applied pressures within the one or more cavities of theenclosure.

Example 58 can include, or can optionally be combined with the subjectmatter of Examples 51-57 to optionally include wherein analyzingincludes determining whether a change in an eye or other physiologicalcharacteristic between the first and subsequent visualizations indicateswhether a specified blood vessel caliber change or other specifiedcriterion has been met.

Example 59 can include, or can optionally be combined with the subjectmatter of Examples 51-58 to optionally include wherein analyzingincludes determining an indication of an intrabody pressure based upon achange in an eye or other physiological characteristic between the firstand subsequent visualizations at different applied pressures within theone or more cavities of the enclosure.

Example 60 can include, or can optionally be combined with the subjectmatter of Examples 51-59 to optionally include wherein analyzingincludes correlating an intracranial pressure (ICP) to the indication ofintrabody pressure based upon a change in an eye or other physiologicalcharacteristic between the first and subsequent visualizations atdifferent applied pressures within the one or more cavities of theenclosure.

Example 61 can include, or can optionally be combined with the subjectmatter of Examples 51-60 to optionally include wherein analyzingincludes using the first and subsequent visualizations to determine achange in at least one eye or other physiologic characteristic betweenthe first and subsequent visualizations, wherein the at least one eye orother physiologic characteristic includes at least one amplitude, bloodvessel caliber, location, or other characteristic of a spontaneous bloodvessel pulsation or induced venous pulsation.

Example 62 can include, or can optionally be combined with the subjectmatter of Examples 51-61 to optionally include adjusting a fluidpressure within the one or more cavities of the goggle enclosure incorrespondence with one or more portions of a cardiac cycle of thepatient.

Example 63 can include, or can optionally be combined with the subjectmatter of Examples 51-62 to optionally include adjusting a fluidpressure within the cavity of the goggle enclosure in correspondencewith one or more portions of an ocular pulse cycle of the patient.

Example 64 can include, or can optionally be combined with the subjectmatter of Examples 51-63 to optionally include adjusting a fluidpressure within the one or more cavities of the goggle enclosure incorrespondence with one or more portions of a cardiac cycle of thepatient over a plurality of cardiac cycles of the patient so as tomaximize an amplitude or other characteristic of at least one of aspontaneous blood vessel pulsation, an induced venous pulsation, orother eye or other physiologic characteristic over the plurality ofcardiac cycles.

Example 65 can include, or can optionally be combined with the subjectmatter of Examples 51-64 to optionally include analyzing the first andsubsequent visualizations to determine an indication of an intrabodypressure based upon a change in at least one eye or other physiologiccharacteristic between the first and subsequent visualizations.

Example 66 can include or use subject matter, such as a method. Thesubject matter can comprise releasing a gauge pressure from an goggleenclosure sized and shaped to be located over a patient eye withoutcontacting the patient eye, performing a visualization of the patienteye at an atmospheric fluid pressure within the goggle enclosure, thevisualization carried out with the goggle enclosure located over thepatient eye, to detect an eye characteristic achieving an eyecharacteristic rebound criterion, and applying a gauge pressure to thegoggle enclosure to achieve an eye characteristic change criterion.

Example 67 can include, or can optionally be combined with the subjectmatter of Example 66, to optionally include wherein releasing a gaugepressure includes opening a controllable vent in fluid communicationwith the goggle enclosure.

Example 68 can include, or can optionally be combined with the subjectmatter of Example 66 or 67 to optionally include performing a firstvisualization of a patient eye at a gauge pressure within an goggleenclosure sized and shaped to be located over the patient eye withoutcontacting the patient eye, the first visualization performedimmediately prior to releasing the gauge pressure from the goggleassembly located over the patient eye, performing one or more subsequentvisualizations of the patient eye, the one or more subsequentvisualizations performed after releasing the gauge pressure from thegoggle assembly located over the patient eye, and using the first andsubsequent visualizations, determining the occurrence of an eyecharacteristic rebound criterion in at least one eye characteristiccorresponding to the release of a gauge pressure from the goggleassembly.

The above description includes references to the accompanying drawings,which form a part of the detailed description. The drawings show, by wayof illustration, specific embodiments in which the invention can bepracticed. These embodiments are also referred to herein as “examples.”Such examples can include elements in addition to those shown ordescribed. However, the present inventors also contemplate examples inwhich only those elements shown or described are provided. Moreover, thepresent inventors also contemplate examples using any combination orpermutation of those elements shown or described (or one or more aspectsthereof), either with respect to a particular example (or one or moreaspects thereof), or with respect to other examples (or one or moreaspects thereof) shown or described herein.

In the event of inconsistent usages between this document and anydocuments so incorporated by reference, the usage in this documentcontrols.

In this document, the terms “a” or “an” are used, as is common in patentdocuments, to include one or more than one, independent of any otherinstances or usages of “at least one” or “one or more.” In thisdocument, the term “or” is used to refer to a nonexclusive or, such that“A or B” includes “A but not B,” “B but not A,” and “A and B,” unlessotherwise indicated. In this document, the terms “including” and “inwhich” are used as the plain-English equivalents of the respective terms“comprising” and “wherein.” Also, in the following claims, the terms“including” and “comprising” are open-ended, that is, a system, device,article, composition, formulation, or process that includes elements inaddition to those listed after such a term in a claim are still deemedto fall within the scope of that claim. Moreover, in the followingclaims, the terms “first,” “second,” and “third,” etc. are used merelyas labels, and are not intended to impose numerical requirements ontheir objects.

Geometric terms, such as “parallel”, “perpendicular”, “round”, or“square”, are not intended to require absolute mathematical precision,unless the context indicates otherwise. Instead, such geometric termsallow for variations due to manufacturing or equivalent functions. Forexample, if an element is described as “round” or “generally round,” acomponent that is not precisely circular (e.g., one that is slightlyoblong or is a many-sided polygon) is still encompassed by thisdescription.

Method examples described herein can be machine or computer-implementedat least in part. Some examples can include a computer-readable mediumor machine-readable medium encoded with instructions operable toconfigure an electronic device to perform methods as described in theabove examples. An implementation of such methods can include code, suchas microcode, assembly language code, a higher-level language code, orthe like. Such code can include computer readable instructions forperforming various methods. The code may form portions of computerprogram products. Further, in an example, the code can be tangiblystored on one or more volatile, non-transitory, or non-volatile tangiblecomputer-readable media, such as during execution or at other times.Examples of these tangible computer-readable media can include, but arenot limited to, hard disks, removable magnetic disks, removable opticaldisks (e.g., compact disks and digital video disks), magnetic cassettes,memory cards or sticks, random access memories (RAMs), read onlymemories (ROMs), and the like.

The above description is intended to be illustrative, and notrestrictive. For example, the above-described examples (or one or moreaspects thereof) may be used in or in combination with each other. Otherembodiments can be used, such as by one of ordinary skill in the artupon reviewing the above description. The Abstract is provided to complywith 37 C.F.R. § 1.72(b), to allow the reader to quickly ascertain thenature of the technical disclosure. It is submitted with theunderstanding that it will not be used to interpret or limit the scopeor meaning of the claims. Also, in the above Detailed Description,various features may be grouped together to streamline the disclosure.This should not be interpreted as intending that an unclaimed disclosedfeature is essential to any claim. Rather, inventive subject matter maylie in less than all features of a particular disclosed embodiment.Thus, the following claims are hereby incorporated into the DetailedDescription as examples or embodiments, with each claim standing on itsown as a separate embodiment, and it is contemplated that suchembodiments can be combined with each other in various combinations orpermutations. The scope of the invention should be determined withreference to the appended claims, along with the full scope ofequivalents to which such claims are entitled.

1. (canceled)
 2. A control circuit for at least one of diagnosing ortreating an eye condition in a patient eye, comprising: a data interfaceconfigured to receive an indication from a detector device, the detectordevice including at least one of: an optical signature sensor system, ablood pressure sensor system, an inclinometer sensor system, a contactpressure system, an MRI system, or an X-ray system; and a processingunit configured to receive the indication from the data interface andadjust a pressure source to apply a fluid pressure level to the patienteye based at least in part on the received indication.
 3. The controlcircuit of claim 2, wherein the processing unit is configured togenerate a control signal to adjust the fluid pressure level in a cavityover the patient eye.
 4. The control circuit of claim 3, wherein thecontrol signal includes the control signal to adjust the fluid pressurelevel toward a target cavity pressure level.
 5. The control circuit ofclaim 3, wherein the control signal includes the control signal toadjust the fluid pressure level toward a target eye parameter value inthe patient eye.
 6. The control circuit of claim 2, wherein theprocessing unit is configured to generate a control signal to adjust acontrollable vent to change the fluid pressure level toward a targetcavity pressure value.
 7. The control circuit of claim 2, wherein theprocessing unit is configured to generate a control signal to adjust acontrollable vent to change the fluid pressure level toward a target eyeparameter value in the patient eye.
 8. The control circuit of claim 3,wherein the control signal includes the control signal to modulate thefluid pressure level in the cavity over the eye.
 9. The control circuitof claim 8, wherein the control signal includes the control signal tomodulate the fluid pressure level based on an indication of cardiacactivity in the patient.
 10. The control circuit of claim 9, wherein thecontrol signal includes the control signal to modulate the fluidpressure level based on an indication of at least one of patient heartrate or an indication of patient blood pressure.
 11. The control circuitof claim 8, wherein the control signal includes the control signal tomodulate the fluid pressure level based on the postural position of thepatient.
 12. The control circuit of claim 8, wherein the control signalincludes the control signal to modulate the fluid pressure level basedon a diurnal cycle including a biological cycle of the patient.
 13. Thecontrol circuit of claim 2, wherein the detector device includes atleast one of a direct, an indirect, or a calculated IOP sensor system.14. The control circuit of claim 13, wherein the detector deviceincludes the eye surface sensor system configured to monitor anindication of IOP.
 15. The control circuit of claim 2, wherein thedetector device includes at least one of a direct, an indirect, or acalculated ICP sensor system.
 16. The control circuit of claim 2,wherein receiving the processing unit is configured to adjust thepressure source based on a relationship between ICP and IOP.
 17. Thecontrol circuit of claim 2, wherein the detector device includes atleast one of an ultrasound system, an OCT system, a camera system, or acolor/intensity sensor system.
 18. A method for controlling an apparatusto apply fluid pressure to an anterior surface of a patient eye, theapparatus including control circuitry with a data interface incommunication with a processing unit, the method comprising: receivingan indication associated with the patient eye from a detector devicewith the data interface, the detector device including at least one ofan optical signature sensor system, a blood pressure sensor system, aninclinometer sensor system, a contact pressure system, an MRI system, oran X-ray system; and generating a control signal based at least in parton the received indication with processing unit to adjust the fluidpressure applied to the anterior surface of the eye.
 19. The method ofclaim 18, wherein receiving an indication includes receiving at leastone of an indication of IOP with a direct, indirect, or calculated IOPsensor system or an indication of ICP with a direct, indirect, orcalculated ICP sensor system.
 20. The method of claim 19, whereingenerating the control signal includes generating the control signalbased at least in part on a relationship between the indication of IOPand the indication of ICP.
 21. The method of claim 18, comprisingreceiving an indication of an enclosure pressure parameter from anenclosure pressure sensor with the data interface.
 22. The method ofclaim 21, wherein generating the control signal includes generating thecontrol signal based at least in part on at least one of the receivedindication associated with the patient eye or the received indication ofthe enclosure pressure parameter.